DEMO-02-19-382 Canceled>f�o Miami Shores Village RECEIVED
Building Department FEB 19 261119
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 O`
Tel; (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
CANCELLED FBC 201�
BUILDING re fl at'eA b-i Master Permit No. T-'Yem l
PERMIT APPLICATION cc-al-16"1503SubPermitNo.
2�fUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
[—]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:? �-V Al 9 Z ST -k�7 1 L.
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: / 1— 3 206— D Ci N -V3 9 D Is the Building Historically Designated: Yes NO L�
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 05,1:- ¢ 2 fl. '2{a R 14 Gad Phone#: S D S� nL OCi i/6 a�
Address: 29-(a N E 9z sT 4* ::1-4-
City: )In; AM i S k OQr=S, State: FL-- Zip: 3313�
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: W I lt/fYQ(J 6 CMr2A- C VA7]e�k /W hone#: ?A, - YX 7
Address: 77Ol tiW 1 1 I 7-6k 8-
City: 4-1l At e ,,*,4 State: ��— Zip: 33 D 1 Y
Qualifier Name: f✓CRAI P-po Q ui A're`Qz7 Phone#: 2Z6 - 497 -5-73?
State Certification or Registration #: C G G 1 Jr 1 S 26y2. Certificate of Competency #:
DESIGNER: Architect/Engineer: _ Phone;
Aaaress: City: State: -7J_� Zip:
Value of Work for this Permit: $ � l 000. 1'Q Square/Linear Footage of Work: q6. -!
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace [ 9 Demolition
Description of Work: OEM 17 L l 5 it P kTN Q 0 0jt l S TR U c Dl £, CSEE PRA w 1 N 0
Specify color of color thru
Submittal Fee $
Scanning Fee $.
Technology Fee
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF
CO/CC $
DBPR $ Notary
Double Fee $
Bond $
TOTAL FEE NOW DUE $ _
(Revised02/24/2014).
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lenders 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 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 o condition to the issuance of o building permit with on 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
OVXER or A/ENT
The foregoing instrument was acknowledged before me this
I" day of
fc—� vr4l(-�i 20 I by
0.SCGY t' 1�Qll('e1,w`fioRp r�s�nafvIkn�cGto
me or who has produced 1' � ( as
Seal:
APPROVED BY
PAY COMMISSION'# GG 044bUZ
EXPIRES: November 2.2020
Bonded Thor Notary Public Undemltars
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day offr-b✓2u/4Ry .20 In,by
0ER IVOR IL02i AlT E2lY, who is personally known to
me or who has produced
NOTARY PUBLIC:
Sign:
Print:
Seal: 'P"
:o
.I
. If
or n�
Plans Examiner
Notary Public State of Florida
Oscar M Zaragoza
My CotaMesion FF 939267
Expkae 12Ioa12019
as
Zoning
(Revised02/2412014)
Structural Review
Clerk