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REV-17-2826Miami Shores Village RECEIVED Building Department NOV 29 2017 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 20 NI BUILDING Master Permit No. 618 PERMIT APPLICATION sub Permit No. �-/ l �-2sz-('�q ❑ BUILDING © ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL [—]PUBLICWORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP L _ _ CONTRACTOR DRAWINGS JOB ADDRESS: 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): O �� ✓1 Phone#: `�"" Address: 36"t A')F foj— S � ' p � City: /liti0616 it State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: _"'� �lyC �• Address: one#: City: State: X--( Zi Qualifier Name: '"�\y ` L= 6), U 6TCAD11- • Phone#: �ov�� State Certification or Registration #: /_- � / 0D '9f 2a Certificafe of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 1Qb • 0�> Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New _ ❑ Repair/Replace ❑ Demolition Description of Work: 4ti --jag vc-c /l ewLG�.14 117X eS 1 4,,,e Z Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Structural Reviews $ Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ ::�8 • co (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 ' i State Zip Zip ' t ' 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 med'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 OWNER or AGENT Signaturexj� , CONTRACTOR The or going instrument was acknowledged before this T fo egoing instrument was acknow edged before day of k 1'�-� J" • 20 by day of 20 by who is personally known to QWXeel ho is personally known to i me or who has produced as me or who has produced as identification and who did take an oath. I , identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Seal: Jorge ortigosa Florida FF 952774 - Exp 02.07.2020 Seal: . �.a_ ___ Notary Public State of Florida FF 952774 - Exp 02.07.2020 APPROVED Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)