PLC-18-3669Miami Shores Village RECRI-VT
Building Department EC 1 2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �i
T I 305 795 2204 F 30
e . ( ) - ax: ( 5) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 7114
FBC 20 1� /
BUILDING CANCELLED Master Permit No.
PERMIT APPLICATION >, Sub Permit No.
F-IBUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF []CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOBADDRESS: [!�L is .S luilii' I -•S
City: Miami Shores County:
County: Miami Dade Zip:
Folio/Parcel#: �\ - 2es
2 � 05 3 " QS '10 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: p
OWNER: Name (Fee Simple Titleholder): / [ �✓i (% �-�f�- Phone#: 506 —Q
Address: /3 A/� 14-5-7,�T7
City:
State:
Zip:.5313
Tenant/Lessee Name: /V//-t Phone#:
Email: �/s �f-fE�4ST�/JSCl/Q�. Cr�kA
CONTRACTOR: Company Name: r V // S-e(V i U PI U M bi n g Phone#: q s L/ 5 2 7 35
Address: %%al9 oNnge Drive
City: �0 V l f State: f l Zip: 3 3 I Ly,
Qualifier Name: rgyi e r 11 ti d tQd-e Phone#:
State Certification or Registration #: _ -7 F C / y 9 9 Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address:
ne#:
State
Value of Work for this Permit: $ 2 .� 5.63. Oy Square/Linear Footage of Work:
Type of Work: ❑ Addition II,,;--❑ Alteration ❑ New ❑1 Repair/Replace
Description of Work: IL�I l q 3]q J r Ol� f &4A SL-� � rJaIyF
l✓ cio5e4
Zip:
❑ Demolition
• .►•...+'r.«.s..., o-sr.; w::.�w,u„_.1.w.w'..:.1 g '��. ! r t?f �C�i, ri: J� �JIC �'
Specify color of coIorYtitrut"tile
r
Submittal Fee $I : '�Permrt Fee $->`� CCF $��
Scanning Fee $ Rad'orrFee $' DBPR $ Notary $
Technology Fee $
Structural Reviews $
Training/Education Fee $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ l6
(Revised02/24/2014)
,
Bonding Company's Name (if applicable)
i
Bonding Company's Address
City
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.
"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 law 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 ¢e approved and a reinspection fee will be charged. l�
Signae / Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of Qua 4,.- , 20 i V by
L-o S #7. RMuJP, , who is personally known to
me or who has produced
CONTRACTOR
The foregoing instrument was acknowledged before me this
_66 day of / J 120 18 by
cI0`J i�Pi c`' d e who is personally known to
as me or who has produced
identification and who did take an oath. identification and who did take an oath.
as
NOTARY PUBLIC: NOTARY PUBLIC:
Sig Sign:
Pri Print: l /-9` 0OV-ID
.a.ewMeAwl-UP"+o6 '
Seal am sa�OX3 r Seal:
6IOZ lZida5 i, KARELIADIAZROMERO
ZLgLL6 d3 # �!SSlWtUC`J ,,fir =�°'�p'
H1iWS 'W NaNll �` ,_ :. MY OOMMNSION # 00 2b26N
ELPI & SepMniDet 25.2022
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APPROVED BY tC!�� I )- ).)- l,P Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)