RC-09-20-2070 Applicationnniaml Snores village
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
BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC ❑ ROOFING
PLUMBING ❑ MECHANICAL DPUBLICWORKS
JOB ADDRESS: I Nfs S 9
FBC 20 _
Master Permit No.
Sub Permit No.
❑ REVISION ❑ EXTENSION RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City Miami Shores County' Miami Dade Zip' .7J i_
Folio/pareeU: - 1- 37 cr, - 013 - 0000 Is the Building Historically Designated: Yes NO
OmpancyType: Load: Construction Type: Flood Zone: BFE: FFE
OWNESt Name (Fee Simple Titleholder): �rl�--fl' �iVeI-OL Phone#:?r96'7A'�-3I
—_ -7 n) G_ 4 /' S'r
M
State:�zip:
Tenard/lnsee Name' rnonea:
Emad: 2Pxm, k i4z,+Q��,,gdamyul , r'OYl'1
1
CONTRACTOR Company Name: �,IIl"r _X4A-) % j� Phon.:
Address _l2f GJ (lpr"Me�cj ( l J3/v
Wes! c1 1. State: L rI Zip: > 7
oyaurtrNamr H/�S F4rJ LF�Lkl/ Phone#: 757- 6X0
State CrtiRotbn or Registration a: 0*0� I :3 % D I Certificate of Competency N:
DE51GNHt: ArddtecVEn&neer: PhoneC
Value of Work for tltb Permit: 5
i
Square/UnearFootage of Work:
State: _ 21p:
Typeof Weh: ❑ onAddition ,,❑fAlteratiio�n G ❑I ,New Ix Repalr/Replace El Demolition
Desorlptloo of wrk _ 1 Q&e ._.J111r—L J 11dJ/L i 11d1'r 'kIZ lc�f�'
S I Q64vwoll WORK?,Is
Specify color oJcolor th,udl Vo•lio 04C sLAfi
�
Submittal Fee $►ermll Fee S CCF $CO/CC S
Scanning Fee $ Radon Fee $ _. Deft S laolary S—
Tedmolow Fee $Tralning/Edu stlon Fee $ Double Fee S
structural Redem s
TOTAL FEE NOw Dug $ _
Bonding Company's Name (If applicable)
Bonding Company's Address
City
State
Mortgage Lenders 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.....
OWNERS 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 toning.
"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 AWimnC As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good folth that a copy of the notice of commencement and construction lien low 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 ofter the building permit is issued. In the absence of such posted notice, the
inspection will notbe.a ved and a minspection fee will be charged.
Signaoue Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
7 ID day of _ .Zs (q' 20 2 V by
L MA ZIq-P-14 ,who�allyknown o
me or who has Produced
identification and who did take an oath.
NOTARY Pt)KJC;
Print:
Sell:
as
The foregoing instrument was acknowledged before me this
ID day of a.a.,.. i, 20 � b
C _ Y
t .5 t�,c,al' w_�pers�now� a
me or who has produced
as
Identification and who did take an oath.
NOTARY
Slgrr_
_ Prinl�
Seal:
•....... uu...................H...... o.b............. 0......... H.1 N...... .......... N......a.0.
APPROVED By Plans examiner
Zoning
Suununl Review
Clerk
IRewredoyN/taul