PLC-18-3671Miami Shores Village D' C 12 018
Building Department (BY: ---
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC ZO_
BUILDING
CANCELLED Master Permit No.P �9 J 3G'
PERMIT APPLICATION
Sub Permit No.
❑BUILDING ❑ ELECTRIC
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
IkUMBING ❑ MECHANICAL
❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 15 E
U A%'� 1
City: Miami Shores
Countv: Miami Dade Zip:
Folio/Parcel#: k i - Z Z 30- 0 S
� - Q5 5Q Is the Building Historically Designated: Yes NO
Occupancy Type: Load:
Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):
LwyA A 5A4) T>4 Phone#: 63on Rq9 - I % 2i
Address: 1502 A E 10 �_, 51"
City: All am j 5 to/CS
State: EL, Zip: 3 3 / 3 s
Tenant/Lessee Name: Al /
Phone#:
` 4lA/, 0
Email: S�� [omcl1
e+
CONTRACTOR: Company Name: f vl1 k r u i u Plum h i n p Phone#: 95 y 3 ?-'7 S
Address: g 6 9 q O/ q v> q e /i r ,- v-e
City: 0,2 ii j -e State: T / Zip: 33 3 t y
Qualifier Name: ,% V I e r 411 dr-CC[_ Phone#: k2 Q- C49 o
State Certification or Registration #: e P G / 4 a- q a '2-4 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 2, �0. Oa Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Specify color of color thru tile:
Submittal Fee $_ ' C Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
DBPR $
Notary $
Double Fee $
Bond $ /+�
TOTAL FEE NOW DUE $ LU_:� . 15� 0
(Rev1sed02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State
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 $250p, 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 be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of 0(:4Z 20 by
, /iJgr Aj S ni k who is personally known 'to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of �dC .20 19 ,by
J -r who is personally known to
as me or who has produced
Print: ✓��
�. 4ULIA C. HAMMOND
Seal: t Notary Public - Stile of Florida
Commission # 00 OU83O
My Comm. Expires May 11, 2021
nF Fl ,
****************,***�AAEA4&dt►�Wlkpe�i�NbwM�otR.
APPROVED BY
(Revisedo2/24/2014)
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
as
Pdnt: .9�e/�i �,� M-2 /Lne-x,da)
Seal:
KARELIA DIAZ ROMERO
` ;; MY COMMISSION II GO 262659
Ev
********A*�AA19lA4dt s20
* ********
x'' Bonded 1Mr Notary Public tlnderwrsers
Plans Examiner
Structural Review
Zoning
Clerk