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REV-09-22-2342, 1020 NE 92nd StMiami Shores 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 FBC 20A-M BUILDING Master Permit No. Pe —V0—C • Z PERMIT APPLICATION Sub Permit No. —Dq' Z 1342- ❑BUILDING ❑ ELECTRIC ❑ ROOFING E!I REVISION ❑ EXTENSION [-]RENEWAL PLUMBING ❑ MECHANICAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR JOB ADDRESS: t r-) ?_ o N) G _(� vt d S - DRAWINGS City: Miami Shores County: Miami Dade Zip: 33 i 3"t Folio/Parcel#:c-1) ® C Z G Is the Building Historically Designated: Yes NO L/ Occupancy Type: Load: Construction Type: _ Flood Zone: BFE: FFE: OWNER: Name (Fee Simple C--eeTitleholder): F? U 0 I `'' � ( LC- Phone#: JC�— J 2� - ©� Address: 102—) v 5 [at` 4 ':�;v City: PA ckM ( S-) LO P'5 State: _ �— (-- Zip: 3-5 1- 4 Tenant/Lessee Name: Email: Phone#: CONTRACTOR: Company Name: A 1 � ® � Phone#: Address: N V3 (_a Lj t L -aST Email: Qualifier Name: C " L'z- q" evi State Certification or Registrationn #: 44 AFC j 4 f6 % 1 � ( Certificate of Competency #: _ DESIGNER: Arch itect/Engineer:3ae ockA 9. �' C v✓ C� Phone#: 2>C'T` S-90— S 66Q Address: �k5b � L4 20�*(- �y� �� - 116 _City: Ll!�t �kk � State:- zip: 33 3 Value of Work for this Permit: $ _ Square/Linear Footage of Work: Type of Work: Addition ❑ Alteration _ ❑ New ❑ Repair/Replace Description of Work: lvvw-- - ❑ Demolition ,41 Specify color of color thru tile: Submittal Fee $ 2 Permit Fee $ CCF $ CO/CC $ Scanning Fee $ ' 3 • DCA Fee $ DBPR $ Notary $ Technology Fee Structural Reviews $ (Revised04/05/2022) Training/Education Fee $ P&Z Review $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 0J • OD 12-ev son 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 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 approv and a reinspection fee will be charged. Signature Signature R or AGENT CONTRACTOR REknowledged before me this The foreeoing instrument as acknowledged before me this 20 a2— , by ` day of � 20 zZ by sonally known to C—CkA c-� who is personally known to me or who has produced identification and whg did take an NOTARY PU Sign: Print: (X- oc Seal: ;y; '.'� of rrrrrrrrr APPROVED BY (Revised04/05/2022) as me or who has produced identification and who did take an oath. NOTARY PU Sign: n;;;: Print: 2✓ r `� v as DAVID Pt1P0 Seal: MYCOMMISSION # HH 136844 +IFv P DAVD PUPO EXPIRES: June 2, 2025 :.: MY COMMISSION # HH 136844 :a• EXPIRES: J 2025 rrrrrrrrrrrrrrrr ,. � , r r� rre�p��ir� r rr rrrrrrrrrrr Plans Examiner Structural Review Zoning Clerk