WS-16-781 (2)Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
PERLDING
MIT APPLICATION�i1]��6��D
Permit Type:
JOB ADDRESS:
BUILDING
6: 9-,"ke- Oia,41- S
MAR 2 4 2016
BY: t_'C
St
FBC 20/`(
Permit No. VJ S I `O `7
Master Permit No
ROOFING
City: Miami Shores County: Miami Dade Zip:)
Folio/Parcel#:
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): W 1 kou" lAunl'ey- Phone4b05) 7 0 — 3 O1-
Address: 7 '-f- I
City: W
Tenant/Lessee Name:
Email:
33)3Si
CONTRACTOR: Company Name:,/ 1 Ao- cons i1cAle1 .eliV 1 C�c�+ CPhone#: (365) Z-6 I — S'6 5
Address: T YO Z S;W r,7 y f7Ye_
�l �S
City: W t State: FL Zip: 3c
Qualifier Name: Ren l mZn t' [[ // Phone#: ��J 1 — �7`% 6 c
L�
State Certification or Registration it- G G C- 1 5 % T �0 q Certificate Competency
Contact Phone#: - 2 k0l - Email Address: 1m (a ✓I C'_0 c n of V _5 -C.0 m
DESIGNER: Architect/Engineer:
-3335
Value of Work for this Permit: $� 000+ O0 Square/Linear Footage of Work: 2 2 ( S
Type of;Worke,gOAddition .�, + �,) ❑ ❑New ❑Reair/Re lacAlteration � ,,,[ p ' p e ❑Demolition
Description of Work:*," �Cd 1eZCly1lG/� / (2/
Color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Notary $
Radon Fee $
DBPR $ Bond
Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ . "L
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
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 noti o c m ante ej; d construction lien law brochure will be delivered to the person
whose property is subject to attachment. Als(�a jerhir ee , �U ti corded notice of commencement must be posted at the job site
for the first inspection which occurs sevenl , r'day� kPing permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature W uk"-11 4� Signature
Owner or►AgentContractors J
The foregoing -inlws_trument was acknwleted befor�e/me this � The foregoing instrument was acknowledged before me this /
day of iCYI , 20 , by W I l `I I 17�f//1 day of 201, by - ✓ I ✓1 ewawe
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY
Sign:
Print:
My
APPROVED BY
NO
Sigr
Prin
MY C&MISSION M 211472146 t My
U RES March 15, 201-7 I
FbndMlolarr6srvioe oorw
U
Plans Examiner
Structural Review
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
Zoning
Clerk