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REV-03-21-775, 9333 N Miami Ave
BUILDING PERMIT APPLICATION AlUILDING ❑ ELECTRIC Miami Shores Village RE:CZ1VE11:) Building Department MAR 2 6 2021 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 202 0 Master Permit No. f'C. — 03: - 2 Q ^ 163 Sub Permit No. PPV- O 3-2-1- -19 5 ❑ ROOFING EVISION ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF CONTRACTOR ❑ EXTENSION ❑RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS JOB ADDRESS: 1 -�) -�> W. M % 4 WA-% 1A V C, City: Miami Shores County: Miami Dade Zip: 3 5 Folio/Parcel#: 1132011P d 13O 1;350 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): PXk ( , C +'- �Q G i f O Phone#: Address: 0 3 33 N r� iG. v..� A-,j-A- City: 1M 4&"^ N SA-,0✓ State: i=L Zip: Tenant/Lessee Name: Pho Email: CONTRACTOR: Company Name: lam- t �✓� c � C._r�.1 St Y� r�2-y%, Phone#: 3 C)' } 31 j Address: �O 3L f [ nr4 +(y{— City: ( r~ State: L_- Zip: 3 3 S Qualifier Name: L �, -C4rr ke � �� c �0 5 try^ Phone#: 3V � � �1 � io'� � t) k � State Certification or Registration #:C-61 I Sa iIN Ut Certificate of Competency #: DESIGNER: Arch itect/Enginee r: jN1f 5 le", � k�i'� l �G� v� o S Phone#: 77� Address: S� �" C— City: I �" State: I" L-- Zip: I 1 Value of Work for this Permit: $ I V © Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ElRepair/Replace ❑ Demolition Description of Work: � 0'� 0j V' C)+ I '" a -r— 0 JrQ ct : t ✓i j }7c F-t iM c-)4 4'rII«ter Specify color of color thru tile:, Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Train!ng/Education Fee $ Structural Reviews $ (Revised02/24/2014) CCF $ CO/CC $ DBPR $ Notary Double Fee $ Bond $ TOTAL FEE NOW DUE $ ;ate ; 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 c ifted copy of the recorded notice of commencement must be posted at the job site for the first ' ch o _ en (7) after the building permit is issued. In the absence of such sted notice, the inspectio ill not be app ved nd a rein ecti ee will be charged. � Signatu OWNER dF AGENT The foregoing instrument was acknowledged before me this s� ��'day of G� �t 20 X1 by �a `Y ir_tC— '�'tCL.c-.;jwh 5 Rersonally kno to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Print: I ;'�' *fi �� ATELEGE NATAKI POWELL IT Seal: ��:• MY COMMISSION # GG 146563` �w EXPIRES: September 27, 2021 Bonded Thru Notary tt APPROVED BY The foregoing instrument was X+fflT ledged before me this �-� day of a ✓tom 20 by who i rsonall know o as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Print: N. r� Seal ;�ot�P�� ; NATELEGE NATAKI POWELL ,. MY COMMISSION # GG 146,551 `' a= EXPIRES: September 27, 2021 Bonded Thru Notary Public Underwiital'i **************** Plans Examiner X41;01& Structural Review (Revised02/24/2014) t:11 Zoning Clerk