RC-15-2193g13�'S
�b
BUILDING
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
AUG 2 6 7015
FBC 20J
Master Permit No. Zf — 2
ERMIT APPLICATION
BUILDING ELECTRIC ROOFING REVISION
Sub Permit No.
EXTENSION RENEWAL
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
D/� CONTRACTOR DRAWINGS
V
JOB ADDRESS: ! _5 ()4f 0 k) &c Avg.
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Phone#: Z
Address: Q1-1-t11 e.. . � C) �70 PQ "- 2.,,.dL_%ti,- ---
City: State: _ Zip: 33 1 S C)
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
(9 . Covvz r N lU C,�,-,->k Phone#: C)y .y (� •� 1 0
Address: 22 2 " (`&-M A.Ar, 33
City: VO% r 0, J/ c 0,v�, �e,��l�„ state: Z zip: 2311 6 C�
Qualifier Name:,M Phone#:
State Certification or Registration #: C Cr C I S S 4 S Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
c..
Value of Work for this Permit: $ �i a0U Square/Linear Footage of Work:
Type of Work: ElElElr
Addition Alteration New uFoRepair/Replace ❑ Demolition
Description of Work: Qr+n call f' 1rt cc sZ 1r wZI 96AS
Specify color of color thru tile:,
Submittal Fee $ 4 �d�� Permit Fee $ CCF $ ' ' CO/CC°$
Scanning Fee $
Technology Fee $
Structural Reviews $
Radon Fee $
Training/Education Fee $
DBPR $
Notary $
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
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 be approved and a reinspection fee will be charged.
Signature Wta��
OWNE or AGENT
The foregoing instrument was acknowledged before me this
2 day of
f Uc3k 20 ) S by
N,ZV^w" C who i ersonally know to
me or who has produced \ D A bL-, as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: �Cy�
Print:lti'
U 4rt, ZZ
Seal: Jjo No��Y PublicStateof Fllori aClaudia AlvarezM4 ommissionFF 13�86
EXPrf@b 06t ".,n
APPROVED BY
Signatures �r
CONTRACTOR
The foregoing instrument was acknowledged before me this
L/ day of O U S " 20 by
who i personally known o
me or who has produced k 1—oak oq? o t as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: ®r
Print-
Seal: �-*'",4� Notary Public State of Florida
Claudia Alvarez
t` My Commission FF 135686
oFpc1' Expires06124/2018
Plans Examiner Zoning
Structural Review
Clerk
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
Zi
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 issuedfl the bsence of such posted notice, the
inspection will not be app;gled and�reinspection fee l be charged. /
OWNER or AGENT
CONTRACTOR
The foregoing instrument was acknow dged efore me this The foregoing instrument was acknowledged before me this
l� day of NO 201t12J by (2 day of �00aH G QA . 20 11 by
who is personally known to ,�e--t d fQGA.)60-':"7 , who is personally known to
me or who has produced as �me or who has produced as
identification and who did take an oath.
NOTARY PU
Sign:_
Print:
Seal:
FOA
identification and who did take an oath.
NOTARY
Sign:_
Print:
MY COMMISSION # FF 046923
EXPIRES: October 20, 2017 " Seal:
Bonded Thru Notary Public Underwriters —A
JOFtGS ROSSEAU
MY COMMISSION *FFJ IW45
EXpIS S May 4 2i} 3Fi
************************************************************************************************************
APPROVED BY /sJ)tL14 3 / }- Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)