FW-4-15-1021 CanceledbMiami Shores VillagecFry
,1
Building Department PR292015
10050 N.E.2nd Avenue, Miami Shores, Florida 33138jB:Y:
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBCu20 /G
BUILDING CANS® Master Permit No.
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
JOBADDRESS: wc-- IOS S�
❑ REVISION ❑ EXTENSION RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load:'�Con�,ststrruu�ctionrlTType:�Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 50 `"'� t(�42`-k' Phone#:
City:
Tend)nt/Lessee Name:
Email:
State:
CONTRACTOR: Company Name: WIX[FASAL &&op' It-sC Phone#: �3os1TG—
Address: -1226 '.JW !96 SA —
City: W14 I State: it Zip: s3i4
Qualifier Name: &-IA8¢ &;;—
State Certification or Registration
DESIGNER: Architect/Engineer:
Address:
of Competency #:
Zip:
Value of Work for this Permit: $ 1 5 000 Square/Linear Footage of Work: 2.S'0 b'aea.t. �ocrY
Type of Work: ❑ A aai*inn ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $ . <-C) '_%n Permit Fee $ CCF $ CO/CC $
Scanning Fee $ .
Technology Fee
Structural Reviews $
Radon Fee $
Training/Education Fee $
DBPR $ Notary
Double Fee $
Bond $
TOTAL FEE NOW DUE $ _
(Revised02/24/2014)
A
Bonding Company's Name (if applicable)
Bonding Company's Address
City Sti
Mortgage Lender's Name (if applicable) _
Mortgage Lender's Address
City
Zip
tate 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 an#-ckreinspection fee will be charge '
OWNER or AGENT
The foregoing instrument was acknowledged before me this
2q day of �jL 20 �� , by
[P6 TFiYl4s %��AG , who is personally known to
me or who has produced Pe s&74�� Ll2#r// as
identification and who did take an oath.
NOTARY PUBLIC: a°`".0.P���o ELLIOT SOTO
* MY COMMISSION B E`t 107020
EXPIRES: August5,2015
Si
Banded Thu RuW Ndery Semm
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Print: �nT�/�— D
Seal
vi
Signat
CONTR CTOR
The foregoing instrument was acknowledged before me this
Zi7 day of ,yy� ?C 20 IJ- , by
&4I-elK� ea r . who is personally known to
me or who has produced Pl !%r`e0'4� as
identification and who did take an oath.
NOTARY PUBLIC: a°`:"•�°;'&�
ELLIOTSOTO
• , MY COMMISSIONfES107020
EXPIRES: August 5, 2015
Sign: ���'�`'aFeuo}`O� BddedTtuu BuNd,n 9erv�.
Print: _s (�
Seal:
APPROVED BY Plans Examiner
Structural Review
(Revised02/24/2014)
Clerk