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DGT-11-1747 (2)Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: BUILDING JOB ADDRESS: /5-1/ ie/ ' ! ll S t FBC 20 lg" Permit No. V G 7"- 9 -1 (- t 7711 7 Master Permit No. ROOFING City: Miami Shores County: Miami Dade Zip: 53 /a d Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): i/ /atul Gat/12,416' Z. Phone #: (% 72 -63/ 6 6 ,re Address: / 3-4 A/. IVs r L- Zip: 7 316 i� City: ,}f4,1 t� t� l �6't�' � State: p: Tenant/Lessee Name: (( Phone #: 1 s.F�rl0 ice f 06(4,41 0 -4.i 1, de £1 Email: CONTRACTOR: Company Name: ©i'� V +0j C° ' (C +t7 o &4 Phone #: 78 g9 -7Qc) / Address: t/°l l t/ ‘C cc/ °Z r City: U4 ea wl ( State: "r C- Zip: -53 (3y Qualifier Name: 3 S WS VQ( . z4 to e Z Phone #: 7j a9 ? 7-20 / State Certification or Registration #: C ' c/r06-A° Certificate of Competency #: Contact Phone #: 776 2 / a/ lac, cl Email Address: J.esces Oovt esf c'p ca Ks-face-00o, co °'t..1 DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: Addition ❑Alteration ONew ❑Repair/Replace ODemolition Description of Work: C ' CoN `T -T- Color thru tile: ******** ** * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ /5, ®c CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 osted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In ,'absence of : uch posted notice, the inspection will not be approved and a reinspection fee will be charged. Sign: ' Print: FIE ff n°z z My Commission Expires: APPROVED BY 01.Ztee, HENRY GONZALEZ • * MY COMMISSION t EE 221657 EXPIRES: August 9, 2016 k . 0 Bonded Tin B tNo1 ySeMces on Signature Contractor The foregoin trument was acknowledged before me this . The foregoing instrument was acknowledge who is personally known to me or who has produced`C" 7)0-4 \I ei 'who is personally known to me or who has produced 1-1 As identification and who did take an oath. NOTARY PUB 1� e. as i . entification and who did take an oath. Structural Review My Commission Expires: (Revised 5 /2/2012)(Revised 3/12/2012) )(Revised 06/10 /2009)(Revised 3 /15 /09)(Revised 7/10/2007) ,91.Z44, WWI GONZALEZ • * MY COMMISSION #EE221657 EXPIRES: August 9, 2016 Bonded Nu BitNoteq Services Zoning Clerk a . Dec/A Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. 6T- ^t('(7c7 Owner's Name (Fee Simple Title Holder): ti iafret Got/211P Z– Phone #: €717z-43 I --6‘,17 Owner's Address: cod, if !/ .S1 City: (`&&-vt r S 110 re State : F L— Zip Code: 33 1 Job Address (Of where work is being done): 1.C4 s e f ! ( City: Miami Shores State: Florida Zip Code: 3.x(68 Contractor's Company Name: CYbe a j� � rz � rGl C � GP vi Phone #: 365– 4/(la 79j" Address: 4/.2111 s' c °-&'- City: M a a ek State: -C- Zip Code: -S.3 ( / Qualifier's Name : T-es us 1/e lot ue Z— Lic. Number: Architect/ Engineer of Record Name: Phone #: Address: City: / State: Zip Code: Describe Work: vi-)0 0e 01 .6 I hereby certify that the work has been abandoned andlor the contractor /architect is unable or unwilling to complete the contract. I hold the Buildi % icial d the Miami Shores harmless for all legal involve Signature wner or Agent W Contractor or Architect The foregoing in ment was aknowledged before me The forego instrument was aknowledged befo this 2e1 day of kit 119 ,2012,by Z1ek'PA GI''nz61 tl—" this ,09-el day of NAI h Irl , 2012.4 Who is personally k own }to me or who has produced who is personally known to me or who has produced !C. '► V ie 4. Lt C 1 as indentification. V L. D tI'a a as indentification. Notary Sign: Seal: GONZALEZ * * MYCOMMISSION$EE221657 EXPIRES: August 9, 2016 Boot Kahn' Nobly Sink% Notary Pub Sign: Seal: �a�;:• .",�� NNWG0NZAI.EZ * MYCOMMISSION#EE221657 EXPIRES: August 9, 2016 �r��oRtt �p &Wenn Hotel Sew