EL-06-22-1635 CanceledMiami Shores Village
ENTERED
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
JUN 2 8 na
BY: a-q
CANCELLED FBc Zo
BUILDING Master Permit No. CL-06-Z2-1635-
PERMIT APPLICATION Sub Permit No.
❑BUILDING E31ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 59-8 N ci 3Co( S-t
City: Miami Shores County: Miami Dade zip: 331 3Sf
Folio/Parcel#:/ - 3ZO (c- O ly " l b ATD Is the Building Historically Designated: Yes NO
Occupancy Type:C + Load: ' Construction Type: � Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): I �a 1 lQ hQ U /Q -z�^ Phone#: 31Z Z'ig 4 5-
Address: �� 0") 1E, q
city: MVavv\i' S1ti0reC State: T- zip: 331 3�—
Tenant/Lessee Name: — Phone#:
Email: wiay 1 0,y10. U'cet6' (36- Q�o C-O
CONTRACTOR: Company Name:
Address: 23 N G ( 0 '�— 5 f- I /
City: Ml (x Mk S //�p� State: rL
Qualifier Name: _ _, 44S /.?R,V-✓D fd
State Certification or Registration #: CC I.3 0 119 3 S7 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City:
Value of Work for this Permit: $1 0 O Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
Description of Work:
Specify color of color thru.
1 �-PA U ✓ d-Q--
Submittal Fee $ Permit Fee $
Scanning Fee $
Technology Fee
Radon Fee
Training/Education Fee $
940 - 3139 -9-? 30
Zip:
❑ Demolition
CCF $ CO/CC $
(
Notary
Double Fee $
Structural Reviews
(Rmsedo2/24/2014)
Bond $
TOTAL FEE NOW DUE$ .I
Bonding Company's Name (if applicable)
Bonding Company's
City State
Mortgage Lender's Name (if applicable) _
Mortgage Lender's Address
City
State
Zip
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.
I
Signature Signature
OWNERorAGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
_day of ) (1P 20 a by
MP2i Awo UaLTA, who is personally known to
me or who has produced �� �aV rift as
identification and who did take an oath.
NOTARY PUBLIC:
The foregoing instrument was acknowledged before me this
Z� day of 1 t) h e_ 20 ZZ by
ad re s ea froS who is personally known to
me or who has produced C_r c as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: X
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Sign:
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Print:
Print:
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Seal: -
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Seal:
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A7YCOMMISSION#GG950477
March 6, 2024
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Comm.:HH222410
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EXPIRES:
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Expires: Jan.31,2028
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NotaryPublic • State of Florida
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APPROVED BY `
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Plans Examiner
Zoning
Structural Review Clerk
(Re isedoz/Z4/2014)