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DS-13-645PERMIT # 1 ' 1iCt '3\10 -1 Y�j L L,,; C 2.w-zoiv3 CONTRACTOR: W :.ti.J� SUBMITTAL DATE: nRESS: _ -C 16 NAME: i icr-/1 777 f9 i'% ( ) RESUBMITAL DATES: PROJECT TYPE: w- ( 1 Ci ( � J e _ FIRE J STRUCTURAL IMPACT FEES ELECTRICAL HRSIDERM PLUMBING NOC MECHANICAL BLDG r A3 SLtore r g!4,1 l av4w'lwl. S_ t r"'_ 03 }ku� we are tet e.) iafhr in eres1 eo1 40 rep,¢ =ova +t work vrthe Pro pie 01 -1Q,4i Gi-t 0 U JJt 1 6 s-} {.,1tow,t Stn ore 'eiv 14,04 0 c - 6.41 j- X011, ( ) feL/l tv t }era ctQAA, 1 VG 14A s44 C-, 7,o tJ P 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: BUILD JOB ADDRESS: A' 0 City: Miami Shores County: Miami Dade Zip: / 2 334 Folio/Parcel #: FBC20k° Permit No. Master Permit No V 7 ' ROOFING Is the Building Historically Designated: Yes NO Flood Zone: Pat) Phone #: (al r4) -, - l01'� OWNER: Name (Fee Simple Titleholder): /Se ' • l Address: o S-S P 5612. si > City: Y l t C�... aa. . S I.....4. -J State: [' p �O6Z rO i Zip: FL 33).3g Tenant/Lessee Naive: Phone#: Email: CONTRACTOR: Company Namur t. d`Fo rit‘a G rot Ul✓, Phone #: QS)C) zzz 1 e 16 Address: 1 JO© Me 4 RN COoy Q City: dck bb►i State: 4 Zip: 33136 Qualifier Name: W 11 failre y 1t� Phone #: (1 ee) z . Z 1016 State Certification or Registration #: C Fa C. It110 0 Certificate of Competency #: Contact Phone#: (1 8 C) 2-2- °`181 Email Address: DESIGNER: Architect/Engineer: 000 h C' '• v t a Phone #: (7°/..) 2S1-43/ 3 Value of Work for this Permit: $ 17 .00 0 Square/Linear Footage of Work: Type of Work: ❑Addition DAlteration ONew ORepair/Replace ODemolition Description of Work: 1 Co it c"r t-ie -51 b fb i +0 fore- Ica `L Color thru tile: *** * **+x*+x************>i ********* *>« ******Fees*********+x+ **** **** ****** *****w************* Submittal Fee $ Permit Fee $ 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 AFJ'1UAVIT: 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In t of such posted notice, the inspection will not be approved and a reinspection fee will be charged. r or Agent The fo ent was acknowledged before me this ti t day of-kr , 20 0L , by CI TA 6034-"I Itt 0111111110, uced whams nersonallv know4ncjsl1 O god ,Its 1*104 ;44A9 did take an oath. NOT ' Y PUBLIC': 09113/2014 • RV PUBLIC ._ Sign: Print Pb ®�/i3��ii My Commission Expires: m 1100 Signature Con ctor The foregoing instrument was acknowledged before me this b i day of Aix t i , 2013 , by (.09% t ) c ' 7 who is personally known to me or who has produced �Illlllifl as identific�t�$w{d.i take an oath. NOTARY PUBLIC': 4 x p iig�, • cot,' ,' ' 3/2414 Print D.cm 58 0 , j .- i •. � ��A ` ` My Commission Expue/�c OF F LO�V \\ 0/lnlltlu .\ * ****,x************* ** *+ *** *+ x+>< ******* *: r< **** ** ******s<********** ** * ****** *****+x***x ****+x***** **** *may *******s * ** APPROVED BY Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk