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PL-10-19-2426 Canceled°1�`lI1:p1� Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 CE IQ llfj�C♦f� E305) 762-4949 BUILDING re>?\a�e� b`INMo.04L-Z3-�Master Permit No PERMIT APPLICATION Sub Permit No RECEIVED FBC 201-5t lP�\-\ pl 9-a42-10 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [-]RENEWAL EYIPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Z.1C NJE \0 -'��'T City: Miami � Shores County: Miami Dade Zip: Wit; E1! Folio/Parcel#: L J9-31 - 013 - We& Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: _9=R: Name (Fee Simple Titleholder)RP, oZ " j", V. , M At h4aR-x>T -k,)H PhoneM W 111 - \30tt Address: 2\ 0 t4� , k 81 CI City: "141 tPrt-k i SM4OLE.S State: 33\61 Tenant/Lessee Name: Phone#: Email: ©V%C<2-1CNSS_6D C�o�.C.n" CASOS gIS--Po81a�idoY CONTRACTOR: Company Name: Kyc� h�ur`t`��d0. �a,� �i�a-.Phone#: •'-ADS-COLS-SVS� Address: k"LkyS'o ems % Q�v City: ism \vim Ct�1 asp: State: `mac \O.o zip: Qualifier Name: ~� 14 na t K� n ��\.. Phone#: State Certification or Registration #: Cs�c Llli..yL\01 Certificate of Competency M DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 3 0 ©• '*' Square/LinearrFF000tage of Work: Type of Work: ❑ Addition Alteration ❑ New ER Repair/Replace ❑ Demolition Description of Work: ! k 5 -7-172 L $ rt u / Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/C4 $ • 't ;. Scanning Fee $ - Radon Fee $ DBPR $, Notary$.. .; .4; . 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 �1. ` 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 construction in this jurisdiction. I understand that a separate p FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... will be performed to meet the standards of all laws regulating ermit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, 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. Signature�nl `�WNER or AGENT The foregoing instrument was acknowledged before me this day of �-eA1 , 20 (`� by . who is personally known to me or who has produced T-b M S1(� 136ii.�a .?r1Ps identification and who did take an oath. NOTARY PUBLIC: Sign: Print: //G / A U O L/-c o L422— Signature�.2i/�/ CONTRACTOR The foregoing instrument was acknowledged before me this A�1� day of 1D-&-vOUmr ,20 119 by 'J Q,'(N+ c who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: Seal: ""'•. LUIS BARIAS g.o VERGNIAUDLECONTE' State of Florida -Notary Public State of Florida•Notary Public _ Commission # GG 157779 Commission # GG 159544 %'•. My Commission Expires •»�4�rFy#ernfhib�tlrflS"November 73, 2021 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Re%ised02/24/2014)