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REV-18-1467BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC PLUMBING REY P L Miami Shores Village Building Department 100SO N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 79S-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (30S) 762-4949 MAY 2 0 2018 BY: S �� FBC 20t-A Master Permit No. G C Sub Permit No. ❑ ROOFING REVISION ❑ EXTENSIONZ6E+I! [-]PUBLIC WORKS CHANGE OF ❑ CANCELLATION []SHOP JOB ADDRESS: I /.� C' O / - E 2 A4 CONTRACTOR DRAWINGS L,YA,� IC �,O . I) nAu7 City: Miami Shores County: Miami Dade- Zip: 31:31 % Folio/Parcel#: it, Z 136 - DOO - o0 Sa Is the Building Historically Designated: Yes NO X Occupancy Type: A -Z Load: Construction Type: / ( k Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Phone#: 3aS - V `/ -3'101 Address: 1000 N• F— 2 4r/F City: y" 1,a n i le State: // Zip: Tenant/Lessee Name: Email: CONTRACTOR: Company Name: _�V d arI/1rlS l alD Phone#: I s -I - 5 q 9- Address: (2S'- 5 - /! 7 City: CL)tS 1., . State: �� Zip: 333 z C, Qualifier Name: State Certification or Registration #: UUGoI G, /O S[/7 ©(l Certificate of Competency #: DESIGNER: Architect/Engineer: & & VeA-'T1/ �l4 / Phone#: )5� - %j% l SSd Address: f/920 j 5YRTG 4I, &-l5" City: Agyii: State:>(Zip: _333Z„S- Value of Work for this Permit: $ 76L Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration /+ El New ElRepair/Replace ❑ Demolition Description of Work: Dtic/ fa61,f/cor'//D.f/ Specify color of color thru tile:. Submittal Fee Scanning Fee $ -3 ' 6Z$ Permit Fee $:::�' (5KZ1 CCF Radon Fee $ DBPR $ CO/CC $ Notary $ Technology Fee $ Training/Education Fee $ 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 kofhure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of comme nt must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In t a rice of such posted notice, the inspection will not be approved and a reinspection fee will be charged. ''II OWNER or AGENT The for oing instrument was acknowledged beforep me this Sir%, day of MAY 20 � b by SUSAN flM-NUL , who is personally known to me or who has produced identification and who did take an oath. NOTARY P Sign: Seal (40ft% Notary Public State of Florida Jeffry J Yao My Commission FF 168481 or Expires 11/12/2018 ******s*****************Awob***,*************** APPROVED BY (Revised02/24/2014) as The foregoing instrument was acknowledged before me this g—' day of eg-�y 20 � by rsonall known to ,br who has produce'dW as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: WALTON I.INDA R. • Commission N GG 1191 1 ` My Commission ExGpir s ************ ****QmtiQ:kil� ********** Plans Examiner Zoning Structural Review Clerk