REV-18-14066pl 18 Miami Shores Village
�-- M Building Department M NY 23 2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 l
BY' 2
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
BUILDING Master Permit No. f C- / 2-�l Z-Z-9Y'7
PERMIT APPLICATION Sub Permit No. -r-1'—.yI & (406
�ILDING ❑ ELECTRIC ROOFING K?"R"EVISION ❑ EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL [-]PUBLIC WORKS ❑ CHANGE OF CANCELLATION SHOP
CONTRACTOR -D DRAWINGS
JOB ADDRESS: ��� � G iU Z ayG �' �7g I've.- 9u, /p1-de� D>Lt�
City: Miami Shores County: Miami Dade Zip: 331 6
Folio/Parcel 112,13r, 0 1)OO 0 5O Is the Building Historically Designated: Yes NO
Occupancy Type:-Z Load: Construction Type: _Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): QAql1.-/ Phone#:
Address: 11 3OOn' g Zir(, Qt�
City: M �1 - State: �� Zip: 33 1C I
Tenant/Lessee Name: Phone#:
Email: '1 ���co
oQ
CONTRACTOR: Company Name: %Gn// tJ�c��/G�c c �eG7 ud tL it klltoa.Phone#: T5-q - / 3 / (, rO
Address: /! X
City:
Qualifier Name:
j1:71.
!ip: 333 ZS
_O^e
State Certification or Registration #: Cq C, D(D00 Q Certificate of Competency #:
DESIGNER: Architect/Engineer:/�G U�/G,� Phone#: $4C.^1�-
Address: •'f- e— 4� City: /( State: / Zip:
Value of Work for this Permit: $ t 1 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: t V i S'< a,) Itje t / P-a// v
J'/� e �nl /o� o P c✓ lI'
Specify color of color thra tile:
Cj Gi wC, 6Submittal Feet '+ `''�""''`Permit Fie $Yl r� CCF $ CO/CC $
wtl. _ ""�•` '."• Pr�titit..P fix. .:..•P ft
Scanning Fee
Technology Fee $
Structural Reviews $
Training/Education Fee $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ M J'(z
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City 1. x 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. _R
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR'PROPERTY:-• WYOU 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 volde exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure be deli ered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement �st b po the job site
for the first inspection which occurs seven (7) days after the building permit is issued. jn the absen such posted notice, the
inspection will not be approved and a reinspection fee will be charged. f 1 I
OWNER or AGENT
The foregoing instrument was acknowledged beforemethis
2Z&4 day of MAY-- 20 a by
S a!j M LNdA l- , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print
The foregoing instrument as acknowledged before me this
day of �� by
me or who has produced
who is personally known to
J
as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:64 e�,),
Print: .—.IAI&4 �• WA L.'rp N
SealL%Tyo
Notary Public State of Florida Seal:Jeffry J Yao
MyCommisabn FF 18E4E1 ► IINDA R, WAITON
Expires 1��12/201a Commission A GG 11911
My Commission Expires
APPROVED BY Okz Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)