DS-14-1002Miami Shores Village
Building Department i MAY 15 2014
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795 -2204 Fax: (305) 756 -8972
INSPECTION LINE PHONE NUMBER: (305) 762 -4949
BUILDING
7 P MIT APPLICATION
BUILDING ❑ ELECTRIC ❑ ROOFING
❑PLUMBING [:]MECHANICAL ❑PUBLIC WORKS
JOB ADDRESS: 35 Al—y 7� '
FBC 20
Master Permit No.
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores Countv: Miami Dade Zir):
Folio /Parcel #: % /dS% L % 63 1/17 2 P6 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): C'o La r, e Phone#:
Address: 9-3 3{ -r;� `� 3 " s+
City: 14f 14 , ®�-" �- ° State: Zip:. T _z zd
Tenant /Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: A D jq9 _ &h % V9 C d-/ i) �;, �� Phone#:
Address: 2� 1 M /.v ' / /_�i
ve-
City: A le; ei- 09 State: ��� Zip: 3 4110
Qualifier Name: a I f Phone #:
State Certification or Registration #: i9 /` % Certificate of Competency #:
DESIGNER: Architect /Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ &Q i Ga0r l ' Square /linear Footage of Work:
Type of Work: El Addition El "Alteration ❑ New ❑ Repair /Replace ❑ Demolition
Description of Work: ^Ot wwl 4lo' i -i'
/_.*� 4-1 /' o A'a /mod , _ _
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
(Revised02 /24/2014)
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $ CO /CC $
DBPR $ Notary
Double Fee $ .
Bond $
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
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 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 t attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection w ►ch ccurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be ap r ed and a reinspection fee will be charged.
Signature
OWNER or AGENT
:The fore of g instruments was acknowledged before me this
day ofd� �� r 20 by
Lsafh e— who is p onally known t
me or who has produced as
identification and who did take an o0th.
NOTARY PUBLIC:
Signature �Q�b
CONTffACTOf
The fore going instrument wa ;acknowledged before me this
day of 20-1y—, by
%O �` who Eznally kn n to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
r ... a - � I W��- -v
✓_� e ' �%r' ttf�L'L%% LLB;
Seal: ;�° °PRY p`8 SANDY Seal:
Notary Public - State of Florida
9' •o; MY Comm. Expires 26, 2015
;, "I .... Commission # Jul EE 116040
ijt 7K,i i�� i� *� # # &�k �k
APPROVED BY e4 � Plans Examiner
Structural Review
(Revised02 /24/2014)
SANDY ROMERO
Notary Public - State of Florida
My Commmm..G Expires �Jul 1266,, 2015
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Zoning
Clerk