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ACT-02-20-353Miami 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 BUILDING PERMIT APPLICATION QBUILDING ❑ ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ENTERED FEB 14 2020 BY: FBC 201--�- �0* Master Permit No. Acr - OZ-20 - 53 Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ((,3 ®d /—)W— 2 QuX City: Miami Shores County: Miami Dade Zip: '-2-'7 Occupancy Type: Load: Construction Type: Building Historically Designated: Yes NO - 't7l Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 1 I _� d © u'12— 2 4 LA__ Phone#: Address: I City: Tenant/Lessee Name: Ertl"; CONTRACTOR: Company Name: Address: Z 4 S Y U E City: k t e, V42 w Qualifier Name: State Certification or Registration #: � C35 06 566 CL of Competency #: DESIGNER: Architect/Engineer: ( n 1 t cn r 4-.n � 'e� i ✓Y Phor Address: S300 +U uJ <<2 S ___Q_ City: Value of Work for this Permit: $ /e6y Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Description of Work: Specify color of color thru Submittal Fee Scanning Fee $ Technology Fee $_ Structural Reviews Permit Fee $ Radon Fee $ Training/Education Fee $ CCF 40 3dS 253 99IS e: rc, Zip: '-'� 1 � ❑ Demolition CO/CC $ _ Notary $ 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 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 tali A"Z�V OWNER or AGENT The foregoing instrument was acknowledged before me this day of 9 ✓�, 20 �� by a Qtj w o is person allysnnwa to c me or who has produced identification and who did take an oath. APPROVED BY as Signature COc=—C_� The foregoing instrument was acknowledged before me this day of i 20 20 by is personally known to me o pro Ufa `1D as identification and who did take an oath. NOTARY PUBLIC: Sign: µ' Notary Public Stataof Mond. uliucZ Print:vvj My Commission GG 237360 7o 7 Qgpp Seal: a++***r...+*x+��:r�w..<+rr:ww+��s•+�e+. <r*aw:ar•:.�...s.....=«w+wx: Plans Examiner Zoning (Revised02/24/2014) Structural Review Clerk n(i �,'0litlli' s'ytl}0 gob iI 5ii�o •r bnpjK gills a 1-1101*0 9 Mouth. Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT#: �1Crt�oz2. 0 -,35) DATE: 16I�� (Name) Contractor o Owner Architect Picked up 2 sets of plans and (other) ��" ��`ne "IC Y ti 1 irS Address: From the building department on this date in order to have corrections done to plans And/or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to con ' rmitting process. Signature: NATURE) PERMIT CLERK INITIAL: S*-— RESUBMITTED DATE: PERMIT CLERK INITIAL: