DGT-07-22-1801 CanceledMiami Shores Village IIS �022
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 ,
CAN EED ER: (305) 762-4949 FBC 20?J
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Permit No. � C." 10
c1TOP Z51-7
PERMIT APPLICATION Sub Permit No.�'
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [-]RENEWAL
`]❑-'PLUMBING ❑ MECHANICAL [_]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Folio/Parcel#: l 13 Z O ICI 14 217 10 Is the Building Historically Designated: Yes NO L"�
Occupancy Type: Load: Construction Type:
OWNER: Name (Fee Simple
City: \' L i calyx I 44/ko'I S State:
iJ
Zone: BFE: FFE:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: G( (O['_ Phone#:
Address: 14 0 Lii C- ) /jc o (0 C(-
City: State: (r
Qualifier Name: "���5 ItiC Phone#:
J
State Certification or Registration #: �i3�( L� 16 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone
_q)
Address: City: State: Zip:
Value of Work for this Permit: $ aj LL,4 S Square/Linear Footage of Work: � `"c'X
tk-
Type of Work: ❑ Ad��d��itigqon El
Description of Work: fl(b
Specify color of color thru
❑ New ❑
❑ Demolition
Submittal Fee $ _'g6' OO Permit Fee $ I Z.5" • C)0 CCF $ „ %O CO/CC $
Scanning Fee $ 3 , li0 Radon Fee $ -z_ - CD DBPR $ Z Off' Notary
Technology Fee $ IZ 'Sb Training/Education Fee $ ' 310 Double Fee $.
Structural Reviews $ (_j_0.OD Z
Bond $
(Re ised02/24/2014)
TOTAL FEE NOW DUE $ 3Z 5
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lenders Name (if applicable)
Mortgage Lenders Address
City
State
gr
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 perm7f with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencementconstruction 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 b prove nd a reinspection fee will be charged.
Signature Signature aw
�T
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The f'o(reegoing instrument was acknowledged before me this
!� I � l — day of ���4 , 20 2'Z by 14 _day of 20 �2 by
is-n�2fN P Z�f�lwa is perspgally known to (9t,�>;vLO'-� P -SI`ca \ �wh is person ly known to
r(/1' lJ.e U
me or who has produced �.ti as me or who has produced as
identification and who
NOTARY PUBLIC:
Sign:
Print:
Seal:
94 identification and who d
EMMANUEL ORDAZ
EMMANU LL Una. r
Notary Publip-Stets of Florida NOTARY PUBLIC:
Notary Public -State of Florida
Commission N HH 42811
Commission N HH 42811
My Commission Expires
My Commission Expires
September 15, 2024
September 15, 2024
- Sign:
Print:
Seal:
d p�ccYdw� -ices
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APPROVED BY 5JLI 1Plans Examiner ^ 7I Z� Zoning
rlZv Structural Review
(Revised02/24/20141
Clerk