RC-03-20-645 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
BCANCELLED
BUILDING
rC?tac&d bI
PERMIT APPLICATION i�C-r7(-222-43
RECEIVED
M' 2 5 2020
BY:
14
FBC 20 (_:�
Master Permit No. 20 ' G'4
Sub Permit
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOBADDRESS: Z&6 N9 41 or
Folio/Parcel#:��9—'��—�%Ol/ Is the Building Historically Designated: Yes N0A1_
Occupancy Type: Load: Construction Type: Flood Zone: BFEE�t.,,/ FFE: 2�
OWNER: Name (Fee Simple Titleholder): ,64 APil�i Phone#:
Address:��gy-p) AIFi L / b-r
City: Nil i bY) ( 5� (7/S State: U Zip: -'tz
Tenant/Lessee Name: Phone#:
CONTRACTOR: Company Name: Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency#:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work forthi Permit: $/J W / DdD Square/Linear Footage of Work:
Type of Work: Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: �"o Apnmbt4 r �DVC61'( fs;w Si&4
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
4
Bonding Company's Name (if applicable)
Bonding Company's Address
City
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
R
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 `t qt all work will be done in compliance with all
applicable laws regulating construction and zoning. �% - t y
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO'YOUR PROPERTY: 1F YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMk* "
`,
Notice to Applicant: As a condition to the issuance of a building permit with an estimaKkval"e,exceedit _6500, fhb Applicant must
promise-img .gd,ff"at a copy of the notice of commencemegr,p�d construction lien 1 4#11lbe delil!(C��/ �oyhe person
whose property is su ` ct to attachment. Also, a certif ed copy of the recorded notice of cdmm' encemerrt must be pbsfetl at the job site
for the first ' s ro which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspectio ill no e a proved and a reinspection fee will be charged.
Signature
INNER or AGENT CONTRACTOR
The foregoing instr t,,was acknowledged before me this The foregoing instrument was acknowledged before me this
V
d day of f Pje- Ct4� .20 O� by day of 20 by
�T W Pdf� CS � �' L( who is personally known to who is personally known to
me or who has produced "t' t— 0 e6l1ELZ- L-LC£LES'F me or who has produced
identificationand who did take an oath.
NOTARY PIALIC:
Print:fVE>4i
Seal:
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APPROVED BY
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identification anckwhodi0 t@ke an oath.
NOTARY PUBLIC:
rSign: .
SINDIA ALVAREZ
MY COMMISSICN W GG 23§140'
EXPIRES: SePlrmber 3, 29220
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Plans Examiner too '�"U Zoning
Structural Review
Clerk
(Revised02/24/2014)