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RC-17-286BUILDING PERMIT APPLICATION ABUILDING ❑ ELECTRIC 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 RECEIVED FEB 3 2017 BY:q-ffl FBC 201q Master Permit No. P C (� 2U (0. CANCELLED Sub Permit No. ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL [:]PUBLICWORKS 0 CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: _JC 0�, NLM ri AYE City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: A ,Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Norfin dacoy) Phone#: Address: MS -k Ow 2Ave, City: Tenant/Lessee Name: Email State: Zip: CONTRACTOR: Company Name: \ r O�g�lJLOh Phone#: -7 �6 — SjLL _j7 -7 Address: 161!, Z S u o _ a• 'k -,Air City: MiCLAA, State: Zip: Qualifier Name: ( Phone#: —2Q 6 `.Si�1 -4 3'71 State Certification or Regist tion #: C?LG':SgC1y0 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ ©� Square/Linear Footage of Work: 1 51) Type of Work: ❑ Addition ❑ Alteration ❑ New A ' l Repair/Replace ❑ Demolition Description of Work: T y"kr� d, nouc ken — NeW . JrU A I WOr I 4PO Z2 ` / It Specify color of color thru tile: Submittal Fee $ SO Plk4 i) Permit Fee $ (00 CCF $ 2 © CO/CC $ Scanning Fee $ :_'711 Radon Fee $ 2. DBPRf$'/2 Notary $ ' Technology Fee $ - Co � Training/Education Feed `4 Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (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 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 t e building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will Acfiarged. A �'.[��, M= or AGENT / / I -- / CO The foregoing instrument was( a _c �knowledge/9 bgfore/meythis day of �1,�!/!�J►7C�C/ 220 1 b by �yTfl \ & who is personally known to me or who has produced _-D� L- as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: ge ;. Seal: MY COMMISSION # FF 048928 EXPIRES: October 20, 2017 Bonded Thru Notary Public Undo rwriere The foregoing instrument was acknowledged before me this me or who has produced i9-�{- by is personally known to as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: yyMAGGE Seal: MY COMMISSION # FF W923 EXPIRES; October 20, 20170t7 Bonded Thru Notary Public Underwriters dq-? **************************************************************************** F APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)