RF-6-16-1668 CanceledMiami Shores Village r�!i y vs
Building Department JUN 15 2016
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 � - :
— Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
CANCELLED FBC 20
BUILDING rGr14c� by Master Permit No /' 16` leqF
PERMIT APPLICATION 1�F.OI-ZLI-q ubPermitNo.
F-IBUILDING ❑ ELECTRIC f'CLROOFING REVISION EXTENSION RENEWAL
F-IPLUMBING
❑ MECHANICAL Ej PUBLIC WORKS
[-]CHANGE OF
❑ CANCELLATION ❑ SHOP
JOB ADDRESS:
f ` `-' Y '
CONTRACTOR
1p
DRAWINGS
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: /I' 32o 4 O/L/ 3o a o Is the Building Historically Designated: Yes NO
Occupancy Type: Load: jj Construction Type:
jlQBl %19 Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 9V30 SVr/ �Y 1 /oN Phone#:
Address: ,; V a L/ IN F 13 ad -
City: mr f 0." f State: Zip: 33
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: ADVANCED CONSTRUCTION SERVICES GROUP Phone#:
Address: 5910 SW 93 PL
City: MIAMI State: FL
Qualifier Name: HIRAM GONZALEZ
State Certification or Registration M CGCO01773
of Competency #:
DESIGNER: Architect/Engineer: Phone#:
33173
7�
Address: City: State: f Zip:
ry
Value of Work for this Permit: $ Square/LinearrcCF��oo��tage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New �1 p6Cscepair///Replace ❑ Demolition
l
Description of Work: Q'laT Ad)- gc'w'✓d 1, AL/-r—J— � 14_ /.�gpe.P
Specify color of color thru tile: ��lr^•t�� /� (� �^
Submittal Fee $ y a Permit Fee $ w CCF $ )-+ 1 0 CO/CC $
Scanning Fee $, 7H Radon Fee$ DBPR$��•�� Notary
Technology Fee$ 3'� Training/Education Fee$ V'� Double Fee$
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ ;), I� 1 V
(Rev!sed02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City 51
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.
or
The foregoing instrument was acknowledged before me this
y�y day of .20 16 by
/I �V 0 cSa4�-rl��Gvt , who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY P7LIC: f
SC_
Seitl: / 'Ll JoseK uiluil
l��/// 0j � COMMISSION I EE831658
* " EXPIRES: 3, 2016
WWW. TNIY.COM
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APPROVED BY
Signature
CONTRACTOR
The foregoing instrument was acknowledged before/me this
day of . J O Z&- 20 h by
-r,7; -t bon W'r - , who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUB
1,�J
co.....
/ /36l-t— /n,/dh - - _
-
t u Cv� Plans Examiner
Structural Review
as
COMMISSION i EE831658
EXPIRES: Sept 3, 2016
www.AARoNNoTARY.COM
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Zoning
(RevisedO2/24/2014)
Clerk