PL-10-24-2688 Canceled�ps•Z1 A,
. Miami Shores Village
Building Department
�`�d,
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 16
Tel: (305) 795-2204 Fax: (305) 756-8972
CAMPgHQNRYER: (305) 762-4949
BUILDING r4e.?le.Ck by P4_16-Zq--z&gf—; FBC 20Z,5
Master Permit No. (� . p — -
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
[94UMBING ❑ MECHANICAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
/ CONTRACTOR DRAWINGS
JOB ADDRESS:_ 3 Yb /ofj. C ?-4 s7A, -
City:
Folio/Parcel#:_&,3
Occupancy Type:
Miami Shores
2c ao (3 G
County: Miami Dade
33r> Is the Building Historically
Construction Type: Flood Zone:
zip:
Designated: Yes NO
BFE: FFE:
Load:
OWNER; Name (Fee Simple Titleholder): yn�0 /A.c 4,G,d,�,� Phone#: oJ- 33- ,30�i
Address: .1 �l //_ i 4 �c
City: !A � State: L.L.
Zip: 7�/JO
Tenant/Lessee Name:
Phone#:
Email:
CONTRACTOR: Company Name:
Address: Z Si /j• y/ 13 5 S
Email:
Qualifi
State Certification or Registration #:
DESIGNER: Architect/Engineer:
of Competency#;
Value of Work for this Permit: Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
Description of Work: ,CdCsd'r 7 '7e
Specify color of color thru
Submittal Fee
Scanning Fee $.
Technology Fee
Structural Reviews $
(Revised04/05/2022)
Permit Fee $
DCA Fee $
Training/Education Fee $
CCF
DBPR $
te: _Zip:
❑ Demolition
0.7
CO/CC $
Notary
Double Fee $
P&Z Review $ Bond $ TOTAL FEE NOW DUE $ D . 00
Bonding Company's Name (if applicable)
Bonding Company's Address _
City State
Mortgage Lender's Name (if applicable) _
Mortgage Lender's Address
City State
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
inspectlon will not be approved and a reinspection fee will be charged.
Signature Signature two ���
Ir
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
_.L,L_ day of _6) 6 e2 20 Z fi by
i(A a 74 o".B. &who is personally known to
me or who has produced as
Identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: v
Seal:
JORGE TOLEDO
MY COMMISSIONS NH 582704
EXPIRES: Augusl 22,2028
APPROVED BY CP�I (}
The foregoing instrument was acknowledged before me this
740dayof DG%yeAi 20 Zy by
�d /L e• .��.fiTt (' . who is personally known to
me or who has produced �— as
Identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Plans Examiner
Structural Review
JORGETOLE00
MYCOMMISSIONSHH582704
ss* EXPIRES: Au 0isjFi 2028 +iswwrr♦++
Zoning
Clerk
(Revised04/05/2022)