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PLC-18-3668a. v' Miami Shores Village Building Department EC 1 2018 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 B Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBCC i201`� BUILDING CANCELUD Master Permit No.zc\A 9 — �3 G69 PERMIT APPLICATION Sub Permit No. ❑ BUILDING ❑ ELECTRIC ROOFING REVISION EXTENSION [:]RENEWAL XLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP /� J (? CONTRACTOR t DRAWINGS JOB ADDRESS: / 1 V �' 1' 'S c� / �)1/1 I I� 1 '" "I 7 4� Citv: Miami Shores County: Miami Dade Zio: Folio/Parcel#: Y\ — 22_ 30 - (25-3 - O S 20 Is the Building Historically Designated: Yes NO Occupancy Type: Load OWNER: Name (Fee Simple City: / / °�'�!✓ eholder): Construction Type: Flood Zone: BFE: FIFE: 4 j/U-�"zPhone#: 7"I©6 -7 5-/ — oe°)v State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Full Ser U i Ge, Plumbing Phone#: 9-';- c/ 3 2 7 'sS $ a Address:q01 O(gr)q-Q dfl V-e City: 0 01y) State: f / Zip: Qualifier Name: Jl Vy Akid rqd - Phone#: C'S Y 6 a c-(-8 9 G State Certification or Registration #: CF C / % 2 `fig' a" 9' Certificate of Competency #: DESIGNER: Architect/Engineer: Add ne#: City: State: Zip: Value of Work for this Permit: $ Z i DE") Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑[ New j `❑ R Cep �air/Rep lace Description of Work: lZP( Q(C ; )y 010C fy040 5'1°'l-"I tiff U4106 Specify coor~dfo/vr~#hru ta'le:, ,'. I i; ry e 1 is P �rY14 Submittal Fee $ Mit Fde. y", i � 1G"'.'ltnsa:.: tn. , sYl.•f4 t;t.": i '�;i,+lr,: r ..;1 Scanning Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF $ DBPR $ ❑ Demolition & i'OlP fh .a :fit r ;+t;i;•'!;:,^i<:::3i31'!�:"y Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's Name (if applicable) AN, ` 1 ". Bonding Company's Address City -!I State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. f' "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE, RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien low brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not approved and a reinspection fee will be charged. Signa Signature re.e OWNER or AGENT 'AwN CONTRACTOR The foregoing instrument was acknowledged before me this 2 2 day of ) mot z--,-- 20 (cam by JP—OY 4-91M �r `'�ctt�-i.� who is personally known to me or who has produced ipL I>Q 6Er- C.Lc -tom as identification and who did take an oath. NOTARY The foregoing instrument was acknowledged before me this day of —! Z") j L , 20 t 2) , by who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: /!l as ;'q'r„ SINDW ALVAREZ Se MY COMMISSION # GG 238273 Seal: EXPIRES: September 3, 2022 , , KARELIADIAZ ROMERO s •.dos ?:: Bonded TtW Nutarl Publk lh�deiMniters W COIrIAOSSION 0 CMG 2UM IV"wefe ********** APPROVED BY � 1.2: - 0' -V Plans Examiner Structural Review Zoning Clerk (Revised02/24/2014)