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DGT-14-601BUILDING PERMIT X Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 795.2204 Fag: (305) 756.8972 PHONE NUMBER: (305) 762.4949 FSC 20 Permit N T Master Permit �' l Permit Type: BUILDING ROOFING JOB ADDRESS: 114405 IDI f City: Miami Shores County: Miami Dade Zip: �33 13 2) Folio/ParceW Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder) V, dlS ��dO Phone#: 3C�6_6 29515 �19c/� � 1016 Address. City: M; 41" i si,01245 State: TenantlUssee Name: N IA - Email: q 33/38 0 CONTRACTOR: Company Name: �,4- ��'USUC�.c�S Phone#: Address:2_3)�L 7',-�T- ST.- City: TCity: ffo lI LU00- 0 State: Qualifier Name: ©SMF_ �r P t Phone#: �5 �� I X071'-2 State Certification or Registration #:CL. ZC 1S l e O3 2 Certificate of Competency #: I� Contact Phone#: Q� �' Z Email Address: OScn YG)qp!G CjG o Cor -y1 DESIGNER: Architect/Engineer. PSG eATi Phone#: `A°$q q-39-2053 Value of Work for this Permit: $ SquareAAnear Footage of Work: Type of Work: OAddition OAlteration ONew ORepair/Replace ODemolition Description of Work: _ � Q---.;1010> D �r-- G.V , Color thru tale: Submittal Fee $ Permit Fee $ CCF $ MCC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 1 q U1. Bonding company's hale (if applicgble) _ Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City S, 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 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 EVIPROVEMENTS 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 a t building permit is issued In the absence of such posted notice, the inspection will not be affroved and a reinspection fee '. ed_ Owner or Agent The foregoing instrument was acknowledged before me this day of 201by"CAB�' N day who is Wally known to in or who has produced who tification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: U-Ujj -L�;l 20 APPROVED BY us - Contractor instrument was acknowledged before me this 20 flLL by ve- ft y own to or who has produced asIdeff 0cation and who did take �'' � PMfi l CISINA RY PUBLIC: Y4� *sSiteUy1oo��5,��a My Commission Expires: -J ^ L , 6 V __-_---____-_-------------------•--•-------------------- ----..-..U-12 - �w..-..-..-w-...w...�..• --- - - ---- Plans Examiner *4 zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10f2009)(Revised 3/15/09)