DS-1-17-249 CanceledMiami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
By-,
_ICFJVED
JAB 1.2017
FBC 2014�'
BUILDING CANCELLEDIVIlaster Permit No. DS I - 11 - Z41
PERMIT APPLICATION Sub Permit No.
'•BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: CT-2:>i r� 1� I .� L CC?�/ ►LD.� N v 0
City: Miami Shores County: Miami Dade Zip:�Gi 39
Folio/Parcel#: I h 3 `D bk-A — 019
1 / (-p I (j Is the Building Historically Designated: Yes NO x
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): YY1GtX:CO� !-i ! -5_ L Phone#:
Address: 17 e i S7 5 S ;4 -, b V
City: I'�i►►1� t State: Zip:'�j 3-'�)L
Tenant/Lessee Name: _ _Phone#:
Email:
CONTRACTOR: Company Name:: J� I&LA I J_Pj i, Phone#:J7}) ' gLj s ' SbZB
Address: 20ci ( u S /-P, Y 1 e lwi ST
City:,;.Y,b//��V-�jG�, �I" 11� `_State:
Qualifier Name: t-1 I T7 1 I)(-- IG (Q Phone#:
State Certification or Registration #:(,LQ I S cD 5 % Certificate of Competency #:
DESIGNER: Architect/Engineer:
e#:
Address: City: State: Zip:
Value of Work for this Permit: $ CX-'0 Square/Linear Footage of Work: G o(z)
Type of Work: ❑ Addition ❑ Alteration 0 New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile: r4e-pk at-�� ��j 'bS�'0% -21- IL4 (L�
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Technology Fee $_
Structural Reviews $
Radon Fee $
Training/Education Fee $
DBPR $
N ota ry
Double Fee $
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
WE
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 a reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of IVIOV 0 rq G F� 20 by
nc s; /�u �'� ,�(' Z who is personally known.io
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: -�
Print: ' y
•,ti�av ALICIA GARCIA
Seal: ;••?�� ���: Notary Public • State of Florida
_ Commission # GG 008382
My Comm Expires Jul 4, 2020
Bonded through National Notary Assr
APPROVED BY
Signature
CONT OR
The foregoing instrument was acknowledged before me this
_ day
of 20 1 by
who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: Ali �rr l
Print:
Seal: =� �'= Commmm # GM53
''` •" Up* October 3, 2020
Bonded thru Aaron Notary
*********************************************************
Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)