EL-10-18-3147 CanceledMiami Shores Village RE::aT
Building Department c10050 N.E.2nd Avenue, Miami Shores, Florida 33138BTel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
CANCELLED IF 20 ` y
BUILDING (cPlaLtd W Master Permit No. :
PERMIT APPLICATION EC-v9• u -1'�L Sub Permit No.
BUILDING 5ZIELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: / 0 /V /1l./
City: Miami Shores 11 -- Countv:l��#b4b Miami Dade Zip: �75/%
Folio/Parcel#: I)- a) - 3ie' o O -5- c �''rrLn eD Is the Building Historically Designated: Yes NO -k—
Occupancy Type: 2-5 Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name /j ame(FeeAAS��impleTitleholder): I-erP5V` 4l KAAU j 1 V f � Phone#:-/ti(0- YV01• cs X`-
Addre��s,s�:! /& � R) L /// tr &--
city✓//i I OL 1 �%l i),-2 S State: )CL Zip: �" n
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
City: J_D�ra S � U7L,=r
Qualifier Name:Rcoe +4 rb
State Certification or Registration #: E C
DESIGNER: Architect/Engineer:
Address: �p�
Value of Work for this Permit: $5
1 �L Zip: ?2y'a (L -,;�
1 + Phone#: o2.2A - (Q7 *�-
of Competency M
State: Zip:
ou
Square/linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑l New K (Repair/Replace El Demolition
Description of Work: �- AQ P 0 r) UA r �s G-A -3 � r� lee n /I, -/A U'✓ r D n ✓v C-f '1
Specify color of coll�ot-r�thru tile:_�� a t
Submittal Fee $ f_Permit Fee $ t!22!!t CCF $ CO/CC $
Scanning Fee $
Technology Fee
Structural Reviews $
Radon Fee $
Training/Education Fee $
DBPR $
Notary
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ `c'1 . 5,9
Bonding Company's Name (if applicable)
Bonding Company's Address
City S1
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Zip
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.
X Signatur
OWNER or t9ff
The foregoing instrument was acknowledged before me this
day of 2 0 19 , by
(.l who is personally known to
me or who has produced as
Signature � 6 A -
CONTRACTOR
The foregoing instrument was acknowledged before me this
dalIy IIof C 0 ��
F by
2 r(1 f Pt 6 1��p who is personally known to
me or who has produced
as
identification and who did take an oath. identification and who did take an oath.
NOTARY
y/PU'B,LIC:_ NOTARY PUBLIC:
Print -1JQ re 51 % 0 I Li j Print: -QrAls ii/t 1'
�P� ,, Theresa M. Collins Seal: 40 , Theresa M. Collins
!WAyA= Commission # GG173704 c Commission # GG173704
a Expires: January 9, 2022 '-` '= Expires: January 9, 2022
''ITy,' Bonded thru Aaron Notary A, „' Bonded thru Aaron No(r
•#i#'#'C#t#til:ttkiifiittittiiittttitiitiitiiYiititiitliiMiiiiitiiii M iitt#tt#ttru Aaron
APPROVED BY .i" !S Z^92�% AF Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)