RF-11-18-3488 Canceled� ^��,.,� Caw
l Li�q Ur ' � 0.
Miami Shores Village
Building Department l g �'g
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY'
Tel: (305) 795-2204 Fax: (305) 756-8972 ("_rI I
INSPECTION LINE PHONE NUMBER: (305) 762-4949 k
CANCELLED FBCG20 (�I'
BUILDING (tPl�c.d by (�FIZ.ZZ_3MsterPermitNo. Ze(y - �`C6__�
PERMIT APPLICATION Sub Permit Nol-FI e - � Lee
❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I CJ I V�j G1 -2— AV S
IJ
Folio/Parcel#: Is the Building Historically Designated: Yes NO _
Occupancy Type: D Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple
L`o w
Address: Co S
City: cs-ns'1 State:
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Nam
Address:
City:
Qualifier Name: 14111
State Certification or Registration #:
DESIGNER: Architect/Engineer:
4( e Phone#: 13
gv g� I -zrd
Z as ff42 ;2 7 /,L
/-/ Zip: 33 16
,;-Cr✓1_� Phone#: JDS 2-?9r' 7�2_G
Certificate of Competency #:
�1211/�H! J Phone#: jo
Address: City: State: /, Zip:
Value of Work for this Permit: $ 220d'o , C" Square/Linear Footage of Work: I t- M
Type of Work: ❑ Addition ❑ AlterationEl New ❑ Repair/Replace ElDemolition
Description of Work: N fl`1 12_1�_p r
Specify color of color thru tile:
Submittal Fee $ elJ C� Permit Fee $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $... - - CO/CC $
DBPR$ Notary:
Double Fee $.
Bond $
TOTAL FEE NOW DUE $ _
(Revised02/24/2014)
4z�Si?-,CLcc�M-�s-ram
GO-An1C
Bonding Company's Name (if applicable)
Bonding Company's Address.
City
State
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 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 ropy 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 feeyvfR'6e?harged.
I
OWNER or AGENT
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before mce� this
day of /N/ 1Q-A-%2C 20 / by day of � ; 20 l o by
zf��i9 who is personally known to �� � ho is personally known to
me eFwkeilarpredaeed V7 meer-who-Itas-prodo[ed as
ideatif eetiorrend who did take an oath.
NOTARY PUBLIC:
Sig : G`�
Print:
Seal:
APPROVED BY
(Revised02/24/2014)
.ideftS*eatiewand who did take an oath.
NOTARY PUBLIC:
1904 IFF 94V91
Plans Examiner
Structural Review
IFF 94Ti91
I fit
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_Zoning
Clerk