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FW-08-24-2251 Canceled
CANCELLED Miami Shores Village r'gI4,ta,) .9y F-W-05-2S-"-7�uilding 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 Ij ELECTRIC E3 ROOFING []PLUMBING O MECHANICAL ® CHANGE OF CONTRACTOR Master Permit Sub Permit AUG 2 7 ENI-o BY: FBC 20 ® REVISION © EXTENSION ® CANCELLATION [3SHOP DRAWINGS ®RENEWAL JOBADDRESS: I0i2"A C'GVI1QUy5C c� City: Miami Shores County: Miami Dade zip: 3 313 D Folio/Parcel#: I I — 3W0(0- 01"I- 2V60 Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): IC I61 C.r cf.a V1 Phone#: 30s- 1`i 1�(00(03 City: %-pia m l �Kiy e S State: �7t. Zip: 3313`6 Tenant/Lessee Name: Phone#: Email: ollV1�G iAMCA11.CbYh v � CONTRACTOR: Company Name: &,&1e Phone#: Address: Email: Qualifier Name: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Address: City: State: —zip: I� Value of Work for this Permit: $ 32 f 000, 00 Square/Linear Footage of Work: 20.43 R 'F o'fG I Type of Work: 0 Addition [3 Alteration e®,,/1New [3 Repaiir/Replace ® Demolition Description of Work: &Ick alum mum �,I�e2 tQ / Specify color of color thru Submittal Fee Scanning Fee $ Technology Fee Structural Reviews $ Permit Fee $ DCA Fee $ Training/Education Fee $ CCF DBPR $ Co/cc $ Notary! Double Fee $ ` P&Z Review $ Bond $ TOTAL FEE NOW DUE $ _ (Revised04/05/2022) Bonding Company's Name (if applicable) Bonding Company's Address city State Mortgage Lender's 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..... 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature LZ OWNER or AGENT The foregoing instrument was acknowledged before me me this 15 dayof PJACCfti ,2000 ,by V 16OL ( I'66(h who is personally known to a produce me orwh Yl• W/ILeS l,rC . as identification and who did take an oath. NOTARY PUBLIC: Sign: t�/�� Print: Kcs� ,A(e V-. `,-o The foregoing instrument was day of me or who has nowledged before me this 20 ,by who is personally known to as identification aAd who did take an oath. NOTARY Print: Seal: Seal: j;sv i,,eicn 1,U0ovN 411nu4 P+pveq L?Ot .i 13(,Sill/X3'WWO)AW AV4 L Zlla HH t UOISSIWW$j Ta 3}<r3M 34I1SIYx APPROVED BY Plans Examiner Zoning pa It 6 Structural Review (Revised04/05/2022) Clerk