MC-13-553Miami 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
9 ------------------
BUILDING Permit No.ut�
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: MECHANICAL
OWNER: Name (Fee Simple Titleholder): f-1 0 R 14 S44 Tt
City: I CtV1? State:��- zip:Igo
Tenant&xtsee Name: Phone#:
Email
JOB ADDRESS: !�
City: Miami Shores County: Miami Dade _Zip:
Folio/Parcel#:
Is the Building HistorleaIly Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: IFO A-UN9 I
Phone# `? 2.9 3 2-7 3
Address: 14 2-S-6 SU-) I Sj;- I
City:
lIN
Qualifier Name: 6L( 4 Ca PN !tg, In-rcc u4-- 1 Phone#: _-?'C To Z
State Certification or Registration #: C- KL (I I q 9 7 �P_Certificate of Competency #:
Contact Phone#: q T6 2 q L L Email Address: ' 0 � '&I- ,ArA_ fow000
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 00 Square/li inea,Footage oi' Work:
Type of Work: UAddress OAlteration ONew)4RepaiAeplace 4 ODemolition
Description of Work: _ C -o v -N dee6 lng; () d1 .0 r ka NA -t'
A
Submittal Fee $ Permit Fee $ CCF $ CO/CC $ �. e
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.
66WARNING TO OWNER: YOUR FAILURE RECORD A NOTICE OF
COMMENCEMENT MAY RESULT Ovk PAYING TWICE FOR
IMPROVEMENTS TO YOUR PRO IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOiMER OR AN ATTORNEY BEFORE
U�
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 the absence of such posted notice, the
inspection will a approved aj4d-re-in-7.ectiona—re—in— fee will be charged
Si Signa
OwneroAgent Contractor
The foregoing instrument was acknowledged before me this The forego*g instrument was ackno edged befor e sA
day of _, 20/�, by &At'/4 1...59vt ac day of 2013— by ✓�rf Y
who is personally known to me or who has produced - {/
=��•bentification and who did take an oath.
14w i t1A 1 U Lit.:
04�r Gve! �i NIKICHA MCDOWELL 1 I
Notary Publ - State of Florida
" My Co pines Oct 23, 2018
e, Sip: ai Publ r State ofRuld
Print
Not Y 23.2015
M CO .@ . ' it mmisston # EE 128810
Of�- � 3I ��/� y pBonoea Through National Notary Assn.
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
ons Examiner
Zoning
Structural Review Clerk