RF-7-15-1808 CanceledMiami Shores Village
RECEIVFIU
JUL 2 0 2M
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
CANCELLED FBC 20 j
BUILDING Master Permit No. Vr
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ® ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING 7 MECHANICAL ❑PUBLIC WORKS 0 CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: C) I to NF= q(n S�-
Citw MiamiShores3 Countv7 Miami Dade Zip: 33 a
Folio/Parcel#: l ' I2,Uo- io,� n Is the Building Historically Designated: Yes NO
Occupancy Type:Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): -h i I CAA rnonea:
Address: qI�O ije qIn -,y
City: H toy -61 SVK)fj/S State: Zip: ��13
Tenant/Lessee Name: ti) -a- Phone#: n�8 (�'���-���
Email:
A ;ftT/C4-1W
CONTRACTOR: Company Name:
Address: ✓`57p 5�7 �3
city: State: f zip:33/7--4
Qualifier Name: jjj r4w Phone#:-�bj 77611-1-43/
State Certification or Registration #: C16ccp/% 73 Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address: City: State:Zip:
Value of Work for this Permit: $ .3 a oU- i70 Square/Linear Footage of Work:
Type of Work: ❑ Addition $ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile: A),/&
Submittal Fee Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
Double Fee $
Bond $ �7 n
TOTAL FEE NOW DUE$
Q
1 P—i—dm /m/UM a%
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lenders Name (if applicable)
Mortgage Lenders Address
City
State
®'
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. I Bence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
or AGENT
The foregoing instrumentWas acknowledged before me this
_ 3 day of
I�p,l�y _ by
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WON
me or who has produced
15 ? ay
identification and who did take an
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NOTARY PUBLIC:
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lltinl�O``\``
Sign: —
Print: ilk\C�.T'L
Seal
The foregoing instrument was acknowledged before me this
14 day of 20 by
Waal who' personally knoyh to
me or who has produced ��� as
Identification and who did take an oath.
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essas
APPROVED BY Plans Examiner Zoning
Structural Review
IYovimdn0/on Ponlel
Clerk
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