MC-03-20-453 CanceledMiami Shores Village
Building Department �:'='�' "RED
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �';�� 2 Nzo
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 BY%
CANCELLED FBC 20n 1-
BUILDING Master Permit No.-OW
-o5— zn-C(SZ
PERMIT APPLICATION Sub Permit No. rnc':03- (J�- 453
❑BUIWING
❑PLUMBING
JOB ADDRESS:
❑ ELECTRIC
Ei '°MECHANICAL
14�5
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade Zip: 33i38
Folio/Parcel#: II'33*2'($1'+ Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 1'YWre, 2 1.QniAf1AN
Phone#:
Address: y%5
tiz `i5j
City: M%va,ns
Stioj" State:
Zip:
Tenant/Lessee Name:
j F-� -
- Phone#:
Email:
(►�1 n
CONTRACTOR: Company
Name: I-h� oA
Phone#:
Address: �
p
t7ySL �
�
City: 'V�II)�
State:
Zip: 33)�
;lliAmI
Qualifier Name: DAui0
Llt%/
Phone#:
State Certification or Registration #: `k w`f5't Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 50'7Sw Square/Linear�Footage of Work:
Type of Work: ❑ Addition ❑ QAlteration ❑•INew
` /� ,/R`e,1Pair/Replace ❑ Demolition
Description of Work: aS-6 d %IVN„w1.i.¢, Poo. W.FitRI dnte %.
91 e&W A-L/
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee
Structural Reviews $ 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
2r
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 insp ti which,gccurs yw n (,')--days-after the building permit is issued. In the absence of such posted notice, the
inspection will n t be a r v reins ection fee will be charged.
The
before me this
nbna day tab✓y 20l by
4Woth.., LQ,JAraw who i ersonallyknow to
me or who has produced
identification aria V flp did take an oath.
NOTARY
Signature aLti
CONTRACTOR
The foregoing instrument was acknowledged before me this
d/aa��y. of 1y 1 WC20 � by
DMO `btlis ,/ who i personally known to
as me or who has produced
identification and who did take an oath.
as
APPROVED BY 6 20-I ns Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)