CC-8-14-1902 Canceled PermitMiami Shores Village 1
Building Department AUG 9 2014
10050 N.E.2nd Avenue Miami Shores Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 BY
INSPECTION LINE PHONE NUMBER: (305) 762-4949
re_p (°,e.e_4 bq FBC 20
BUILDING C.'C-y-1G-4u7 Glc cj& aster Permit No. I
PERMIT APPLICATION C t jl(0144 Sub Permit No.
dBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:-�f 1JL'j l JY
Folio/Pa
Occupancy Type: Load
OWNER: N (Fee Simple Titlehol
Address:
,�',,
Zio: ?,
Is the Building Historically Designated: Yes NO
Construction Type:
M4,1- 0 A4
City: State:
Tenant/Lessee Name:
Email
Flood Zone: BFE: FFE:
Phone#: 3v J 7 "10 2-
Phone#:
-'s3).3
CONTRACTOR: Company Name: Y,(. �'- ��'S ��G'� r�� i'�`� ► �-�C i 1C'��; Phone#: `l q L!
Address:
City: M r--r State: *r Zip: 35319
Qualifier Name: 3i=�VIZTA Phone#: �.
State Certification or Registration #: GlJ G 1 -/ 3 cf 22- Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address
Value of Work for this Permit: $
/
Type of Work: ❑ Addition ❑ Alteration
Description of Work: & I cc CG-
��-�—
Specify color of color thru tile:
Submittal Fee $- tso ' M Permit Fee $
Scanning Fee $
Technology Fee $
Radon Fee $
City State: Zip:
Square/Linear Footage of Work:
❑ New 2-'Repair/Replace
?cz�-"c rcf)r� ('%- C or�
Training/Education Fee $
❑ Demolition
CCF $ _. CO/CC $
DBPR $
Notary $
Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $
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 the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and,ti'reinspection fee will be charged.
Signature Signature
OWNER or AGENT CON RACTOR
The foregoing instrument was acknowledged before me this
day of `SUu , 20 t'(, by
b� who is personally known to
me or who has produced �'�)yL as
identification and who did take an oath.
`\\0%klllllllfl�//��,,r`
NOTARY PUBLIC: �� •. ''
The foregoing instrument was acknowledged before me this
day of 20 _J, by
who is personally known to
me or who has produced/5 �36 �Z3 02,0176s
identification and who did take an oath.
NOTARY PUBLIC:
� � t
—_ _
Sign ='ter L.J. Sign:
Print 'C.'� ` rint: f C
Seal: �fff''/h//1l111W0011",Seal:
=o Notary Public State of Florida
Joanna M Feliciano
• My Commission FF 082753
Narn Expires 01/12/2018
APPROVED BY
Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk