PL-09-19-2286 CanceledMiami Shores Village RE�E,�SO
Building Department «, 2
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 a�
FBC 20iT
BUILDING CANCE LLEDster Permit No.
PERMIT APPLICATION Sub Permit NOB - Cq-iq-'�018
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [-]RENEWAL
U/PLUMBING ❑ MECHANICAL [-]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 2 k t7 (\\r_ C L 1 '�1
City • Miami Shores County Miami Dade Zip:
Folio/Parcel#: l 1--2'7 3 k- O k 3 - n WE A Is the Building Historically Designated: Yes NO
Occupancy Type •'�H Load: Construction Type: 4c:'- —Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):MAolMAPPEiZu"1APhone#: 7A?G—i1i-1.3CXf
Address: 2� C� T� sc • �O'i �' T
City: " \ 1-d2y—C State: Zip: 'So?>
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name:
Address: �� /JC I
City: IJ• M
Sk
Qualifier Name: I J►�� ✓` tSt-e.X.Lsw..( Pnone
State Certification or Registration #: C F r- 1c•/2 bS t S Certificate of Competency #:
DESIGNER: Architect/Engineer:
Value of Work for this Permit:
JFar5 3'S'13701
zip: -4,%% t
305aa•a S I o•!
State: Zip:
Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: W 6 F2019- L64:. N I 1 T 8X1(2N
Specify color of color thru
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $ CCF $_
Radon Fee $ DBPR $
Training/Education Fee $
CO/cc $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City ]i
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 on 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. )A
Signature Signature
_ KJ
ER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
2 t day of ���� M 6C.Q- , 20 by e� day of §!�ef 20 11 by
tJ J ITH �.jp ��pp�rul o is personally known to 0AJ ?J64 who is personally known to
me or who has produced ��� V'C-1Z7IJS'Eas me or who has produced Oarjn- %1 g as
identification and who did take an oath. identification and who did take an oath.
NOTARY P BLIC: NOTARY PUBLIC:
Sign, Sign:
Print '5�-( NiI&- LAJ C1 Print:
Seal: Seal: MATTHIEW SIERRA
•,;w.'Kti,,. SINDIA AWARE 77 MY COMMISSION N GG088DOE
H` MY COMMISSION B GG 238273
' EXPIRES: September 3, 2022 EXPIRES Me�A 28, 2021
at pubimund?rxMms
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)