PL-03-20-454 CanceledMiami Shores Village F'NTr.'RED
Building Department Mai a2Zo 0
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE LINE PHONE NUMBER: (305) 762-4949
CANCELLED FBC 201-1�e�
BUILDING Master Permit No.b�'OJ1--W--452—
PERMIT APPLICATION Sub Permit No. N_cr_�_ ZU"HS 1
❑BUILDING ❑ ELECTRIC ❑ ROOFING
dPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
JOB ADDRESS: 410
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel#: ' I' 5m, Is the Building Historically Designated: Yes NO _
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): I-4n M"j Upj"ai i Phone#:
Add
City: MIAMI S42MO State: t
Tenant/Lessee Name: ---
Email: n
CONTRACTOR: Company Name: 1 lu _L(Lt08 Ylo,_ Phone#:
Address: (I %)o 'Sly_ �L4
City:
Qualifier Name:
State Certification or Registration #: U, PC oi't 5 � Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address: City: State:
o�
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
Description of Work:
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
Technology Fee
Structural Reviews $
Radon Fee $
Training/Education Fee $
3wyl
23
❑ Demolition
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 S1
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 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 sev (7)-days-after the buiding permit is issued. In the absence of such posted notice, the
inspection will not by`6`p)yVF0p4q rqfnsppctionfee will be charged.
NT
The
before me this
�tS day of 20 --tC, by
Ur nre.., UMA,4w who is er Wally kn n to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
dayof MAKW 20,3O by
who p rsonally 'now to
as me or who has produced
identification and who did take an oath.
NOTARY
M o 5. Sig
as
1..+:+r.::.:.:r+:r:.rrrr.+:r:rr«*+rr�r�r�r**www:r*w**•�.�r•*sl.,rww«*+x:rsrr:rrw
APPROVED BY �� 3h1dr Plans Examiner 3 Zoning
Structural Review Clerk
(Revisedo2/24/2014)