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ACT-12-20-2908
iami Snores Village RECEIVED Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: ' 0— (355) 795-2204 Fax: (305) 756-8972 INSPECTION ;TINE PHONE NUMBER: (305) 762-4949 / ^�-� F 2® BUILDING Master Permit No,�(`j-- I _ �Q j PERMIT" APPLICATION Sub Permit No. &UILDING ❑ ELECTRIC. ❑ R()0c:;1.1G ❑ REVISION ❑ EXTENSION ❑RENEWAL DPLUMBING I—] MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRE3L. City: Miami Shores Count ; Miami Dade Zia: FoGoj"arcs i4 . Is the Building Historically Designated: Yes NO Occupanc,,, Type: _ Load: Constriction Type; __Flood Zone: BFE: __u. FFE: OWNER: IVarne (Fc-4 ima'_=' itleholder `' k)^'- ,.1.P�✓ ti 1 Phone#: (� j�! 3�t� _..- Addr City: 4k k S ate: �- Tenant/Lesse-m Name: Email Phone#: CO`1,TRACT1.': Cornpanv Nary; : �~ ,n \ z � _ Phone#: A&L sss: Cit hA Qua; rrer game: J - c'—_.Phone#: State Certification or Registratio„ 4: � N 5 � 5� ©© S 00 Certificate of Competency # DESIGNER: Architect/Engineer:,>sr Phone#:S'" J \ ``�� Ad.1 ar=ss: �d C.t3 � city: State: -r' 4acti� K Zip: ( �, Value of :r~ 3 t s^ (oo®b _ - Square,. Linear Footage of Work:. Type of ❑ Addi{;on �Alta-ation ❑ New ❑ Repair/Replace ❑Demolition Descripti,��P.�1.�,QAre��c,/1_ Submittai we Scanning kee , Radccn Fee $ Techr?oia:;v 'rmining/Education Fee $ Structural °d 1;.<<ews It _ CCF $- -_. DSPR $ _._.._. CO/CC $---___.___ .-. Notary Double Fee $ 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 low 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 absenc of such posted notice, the inspection will not be approved and a reinspection fee will be charged. �GGdCL11i Signature__ _ Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of .. µ ; 20 zU , by ; =� day of�0.�C�L 20 n�-'� by SCAN s�N J n J. tc G y�� S4i-hj who is personally known to "��w d 1 Roe� �rsonall kno5tin to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUB NOTARY Sign:____ _ Sign: Pr • .... _. Print: Se,: CortNnissbnl«GG249916 Seal: ay �` Expires November 12, 2022 for Vie•' ggtdOaThNT I*klsmm800,% 7019 ;o<PPxe�e(c, SINOIA ALVAREZ �? *- MY COMMISSION i` GG 238273 o= FIRES: $ rt: ;t'•ber 3 2022 Bonded rn u N'A y ub is tindeiv rl ers -srsF.e�•ran•�raz�c<wx.xaam.+uu.a.�n.=wa APPROVED BY Plans Examiner _ Zoning Structural Review (Revised02/24/2014) Clerk Miami pores village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax; (305) 756.3972 RECEIPT SATE: 117� 'PERlAl T Q 1, (Name) contractor (-��`� r� .NT Owner Architect � Picked up %sets of plans and (other) r Address: /J rom the building department on this date in order to have Corre�tionS done t0 plans A:. L get Coant�j stamps. I understand that the Mans need tc e b51Ug't back to Miarni Shores Vill; -- in-; (inn mansrtment to continue permitting Process. Signature: PERMIT CLERK INITIAL: , c-- RESUp,MITTii ED DATE: PPRUIIT CI EIRK ii 17AL: