RC-11-831 Miami Shores Village
MAY ® 9 201
Building Department BY-. 2---.-............
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 No. I ��
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: BUILDING �jROOFING
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OWNER:Name(Fee Simple Titleholder : L'v V-, YY Phone#:
Address: too z)
City: M491 90,; State: '� Zip: j�✓�
Tenant/Lessee Name: WA Phone#:
Email: Wf"' &MAIL , CiO
JOB ADDRESS: !�!-:�' Ne q z
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: ''
Is the Building Historically Designated: r Flood Zone:
y grated:Yes ..Q
CONTRACTOR:Company Name: A40%-t? �'�G Phone#: ��� 71��7
Address: Z '41 ��'Cf� `'
City: /� /` State: R✓ Zip: -A 34 Z°" �y
Qualifier Name: P'I rf6m rtcLi C' Phone#: N-4
State Certification or,Rep
Registration#:t16I ee 1510-77,3p Certificate of Competency#:
Contact Phone#: q5�1 '7q3 1S 1-7 Email Address: t i I dG,VS t�G 9 .42 L �l
DESIGNER:ArchitectEngineerW I M U Wig f-6 �{ M l
Phone#:
Value of Work for this Permit:$ DO Square/Linear Footage of Work: `15 '
Type of Work: XAddition 4dteration ❑New Repair/Replace ❑Demolition 11�
Description of Work: O� P� O� 41-Us.r-.� COLIWa-
s4cs 1 G$S 4? SiWW-,g I t4 t.JJD I t-►6 Q Dud t,•c i 0Hc
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$ &®A ms
TOTAL FEE NOW DUE$
L
e t k
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.....
IOWNER'S A"AVIT:S 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. ,
"WARMING TO OWNER: YOUR FAILURE TO RECO IRD A 'NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAiING 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."
el"
Notice to Applicant: As a condition to the issuance of a bui i an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of tion lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a c ecorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) day after th&'b�uilding.permit is issued. the absence of such posted notice, the
inspection will not be approved and a reinspectior7 fee will be-cl(ir*gbd"
Signature' '"�^^� Signature
Owner or ent C ntractor
The foreg i i trumentt was ac 0 1 ed bef 1 /me' s The fpFegoing instrument was acknowledged before a this
day o ,20_,by v 'ilk ,20 LL by
identification and who did take an o � 1as identification and who did take an oath.
N OTA PUBLIC: 1
NOTARY PUBLIC•
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APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)