PL-14-1822Miami Shores Village IVB'
Building Department AUG 202014
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 SE,Y
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
FBC 20 t3
BUILDING Master Permit No. I�-[ i �- -;`'
PERMIT APPLICATION Sub Permit No. V1-- a I Wsz
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING [:]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: eF L �} 'F
City: Miami Shores County Miami Dade zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: 9 Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): K-�� Ty k & 0,06TI-w— Phone#:
Address: 153 ,h' i- q-7 s7-n�
City: Mr 044( C'k6--es; State: Zip: •3'5 C 3 F`
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company
Address: ,,�� 4
City: /-l0 mss.
Qualifier Name:
FC
State Certification or Registration #: C71 -'e- Certificate of Competency #:
DESIGNER: Architect/Engineer:
e#:
gra -7
zip:
.j09- 9'ot
Address: City: State: Zip:
Value of Work for this Permit: $ / A 400, do Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: ` KC%Ku.�� _ PCat t9 cqo �t`c �`�r-S p L-c>a-s, f X r -S T�-►s� S . ALL f-1 XYur eS
TO t o c A -rt o —�- ,
Specify color of color thru
Submittal Fee $ !!0' - �D Permit Fee $ /!5 0` CCF $ 1 ° -0 CO/CC $ 0
Scanning Fee $ co Radon Fee $ DBPR $ d- Notary $ fA
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $ -('-A
TOTAL FEE NOW DUE $ `I
(RevisedO2/24/2014)
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 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 not be approved and a reinspection fee will be charged.
Signature
OWNER A ENT
The foregoing instrument was acknowledged before me this
T�— day of &Le�� , 201L , by
who is personally known to
me or who has produced �l e" r Ltz-' as
identification and who did take an oath.
Signature
/7
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 4�w��� r . 20J by
R�V'Jay Xv who is personally known to
me or who has produced '1D e- f3A r L—' as
identification and who did take an
NOTARY
Sign:_
Print:
Seal:�►.- Seal: Y � REBECA M. PASTRAM
MY CONN ISSION 9 EE872624 M. PASTRANA MY COMMISSION # EE872624
MCOMM
a
EXPIRES: February 07, 2017 %ear EXPIRES: Fdiruary 07,2D17
APPROVED BY 8'-Z-1 -f 'e Plans Examiner
Structural Review
(Revised02/24/2014)
Zoning
Clerk