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REV-07-19-1654, 9050 NE 8 AveT6o��,�6 LE3(, L-Pz, w Miami Shores Village Nr-BRED Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tole (305) 795-2204 Fax: (305) 756-8972 BY: FEB2 4 2Q20 V INSPECTION LINE PHONE NUMBER: (305) 762-4949 �..� C�Sl.1.. F BC 201� b� �I�z� BUILDING �a�� _ _ �) Master Permit No. F-EV- 07- Icl - (,>LI4 I S-i �J PERMIT APPLICATION Sub Permit No. Y ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL [PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: `% N F $ A�-,z_ City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: , 3 La 6 — Ol 1 - 0,0 Z.0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder): G q{_� � S T� 6 CIQ (L-L C Phone#: ()'37`{' " 3S-Lc) Address: I F j 6'L City: 1k) tVV c( r.A 'i P�_A o,c State: F L Zip: 3 3 l (� Z Tenant/Lessee Name: Phone#: Email CONTRACTOR: Company Name: ff IA v (L e v�no•� 2�� .. p � m � nTe ngh� Phone#: (`)-sit J Address: -S 70'3 NW V '7 err . City: Z.Vi^C4ro.C_ State: = Zip: Qualifier Name: _5_k4 vey A©e-�t -0 �" Phone#: 0L) State Certification or Registration #: Certificate of Competency #: (_ fC I Lf DESIGNER: Architect/Engineer: Phone#: Address Value of Work for this Permit: $ Type of Work: ❑ Addition ❑ Alteration Description of Work: v. CC c. (v Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Structural Reviews $ City: Square/Linear Footage of Work: EI New 0 Repair/Replace V__d�-c- �" 'P.- e0.f � V tp-1— c 4 CCF $_ DBPR $ Training/Education Fee $ te:_ Zip: ❑ Demolition t ca CO/CC $ Notary $ Double Fee $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ 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 Zi 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 X OWNER or AGE The foregoing instrument was acknowledged before me this tl day of �e)Vuor20 o1a by 5l�ai (' �c•: who is �rsonally known"o me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 0.Vac >�� Cfo as Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of20 -Z-C3 by �a,t y ±� - ��'�► °� , who's personally know Ito me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: r- Print: Seal: i' Jorge Nieto Seal: (� �4 Nowry Public - State of Florida Commission #GG 95563 z Expires 4/1812021 APPROVED BY cs Plans Examiner Jorge Nieto Notary Public - State of Florida Commission #GG 95563 Expires 4/18/2021 ************* Zoning Structural Review (Revised02/24/2014) Clerk