CC-10-19-2471 CanceledRAdgd 1012512011 Miami Shores Village
Building Department Rr;�zN
,1/D
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 201--f CPA-"
BUILDING Master Permit No. CC ID- 19- a4J 1
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: y�.z A�� (, ,y j
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load:,
-;*Air 930/
OWNER: Name (Fee Simple Titlehi
Zone: BFE: FFE:
CONTRACTOR: Company Name: _ _ L9,4 Phone#: ZVC -3 q r/- 6 07`/
Address: L-I 7 A41 1,4 4V
City: P1 i [i am,I i l State: -77 zip:
Qualifier Name: 74-t11 E e Phone#: 7y6 - 5r(—(07�
State Certification or Registration M. el 7 9 7 Certificate of Competency #:
DESIGNER: Architect/Engineer:
Value of Work for this Permit: $ 0-0 0 Square/Linear Foota of Work:
Type of Work: ❑ Addition ❑ Axeration n [1 New � Repai�eplace
State: _ Zip:
❑ Demolition
Description of Work: / I /r i '4c — -r °"°A'/' a 15" o r
�- �na't� DESK rl�co0./N l
Specify color of color thru tile:
Submittal Fee $ -� Q ..Permii_Fee.$
Scanning Fee $
Technology Fee $_
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $. Notary'.
Double Fee $
Structural Reviews
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City SI
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
ac
Zi
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. r,.
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of b 'L_ 20 4 f . by
C�12t35oPfilL J . who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
5i
Print:
Seal:
ssssssssss 'si's#
.:.rr
APPROVED BY
(Revised02/24/2014)
EDGARPAEZ/
COMMISSIONd/GG 304963
EXPIRES: June 22, 2023
CONTRACTOR
The foregoing instrument was acknowledged before
/m�e this
(- dam/ Ur.�v . 20 Js—, by
Tow t e t .n<a �.F'� who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Print: lni/" yl-4, frrGG 7/
,-
Seal: EDGARPAEZ
MY COMMISSION # GG 304963
EXPIRES:June22,2023
'•:eo's iioc, Bonded Ttru Notuy PuWUMnwMws
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Plans Examiner
Structural Review
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Zoning
Clerk