FW-5-18-1494 CanceledBUILDING
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
+AW ffM� f R: (30 ) 762
1 LI R: (305) 762-4949
(,ejpI4,tad 1 j Fin ,a6j0-(EyS FBC 2017 pA
Master Permit No. )w is — 14�R4
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
Sub Permit
❑ REVISION ❑ EXTENSION [-]RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOBADDRESS: [. % k%fY/UE Oi,UI� 1=,wt
& 33/3s USA
City: Miami Shores County:
Miami Dade ZiD:
r
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load:. Construction Type:
Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): +rrc U C- HCY PM65
TNC. Phone#:
Address: /0 5S 1 7-C 5C1+i1JIi [3"1--)
City: IgU ML State: Ft-
Zip: 3 �i
Tenant/Lessee Name:
Phone#: 3dS' $ Q 3 - 7 2 y!
Email:
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CONTRACTOR: Company Name: _�fkas[ ,2tr��T.4UV
Phone#: 7�f 0 - t{3'�i ' 97gd
Addresss:l��5$S N/W�pr3y�6rrh ST
City: U6NN A r
7 State: LPL.
Zip:
I^6"-VR
Qualifier Name: &,go26 F. / FDL6
Phone#: 5-2 S - Z 531
State Certification or Registration #: C iC 060 2 wo
Certificate of Competency M
DESIGNER: Architect/Engineer:
Phone#:
Address:
City: State: Zip:
Value of Work for this Permit: $ CIOW Square/Linear Footage of Work: I Zo
Type of Work: ❑ Addition ❑ Alteration ❑ New
❑ Repair/Replace ❑ Demolition
Description of Work:
�0 9619 AC�Ex19rRED A5ffir
FW 11-I�-2W5
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
CCF $ CO/CC $
Scanning Fee $ Radon Fee $
DBPR $ Notary $
Technology Fee $ Training/Education Fee $
Double Fee $
Structural Reviews $
Bond $ O
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
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 'apermit 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,'a certified copy of the recorded co cetRerthva s[st be posted at the job site
for the first inspection which-sccurs seven (7) days after the building per t is issu n [he absence ofch posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature�.tL
OWNER or AGENT
The foregoing instrument was acknowledged before me this
jt* dayof 9aA , 20 �by
AA I t Fit N who is personal�rown to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: t+_�DL-'(1'Q. u�Yr\_-'G�tt
as
The foregoing instr� ment was acknowledged before me this
S. day of tt , 20 -[A_, by
eWCOLR� who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Print: .•`-V'$°o
ehOrah F Felicia
11 Print:_
uu
F FRlidil
Seal: ':
Commission 0 FF973015
�'�=
Bet erah
Cemml$$IOn / FF973015
_
Seal:
Expires: April 20, 2020
'=
Expires: April 20, 2020
ati
Bonded thru Aaron Notary
P
Bonded thru Aaron Notaryy
APPROVED BY
�++#*++++#+r#t++###***t+++#***##++++r+###r*+r++tt#+rtttr++t+r#+###t##+r#+
r 1 Plans Examiner
Zoning
Structural Review
Clerk
(Revised02/24/2014)