MC-13-1224_ Miami 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
BUILDING
PERMIT APPLICATION
Permit Type: MECHANICAL
JUN 0 3 201
r
FBC 2010
Permit No. ^ L ''���� S!
Master Permit No.
JOB ADDRESS: / D /8 &S&,,4&/
f�
City: Miami Shores County: Miami Dade
Folio/Parcel#:
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): Phone# -Z9 fU `SL�O
Address ,,
City: Zip:
TenantlU e: Phone#:
Email: f I
CONTRACTOR: Company Name: _- a i C "Q •1- (� C Phone#:
Address: 4' ® l 0 S C'" 3 2 -
'City:
,City:
Qualifier Name:
0
10(l Zip: g,
'Ea +1 Phone#: 4-" 8 (V
State Certification or Registration
'#: C �-C C i 2 eY ff% Certificate of Competency #:
Contact phone#: Email Address: YO
DESIGNER: Architect/Engineer: Phone#:
Value' of Work for this Permit: $ Alm 49 Square/Linear Footage of Work:
Type ,of Work: DAddress Alteration ONew ORepair/Replace ODemolition
Descriptions of Work: Z-'� 'e`�.� •,. 8 �• '� �-- ts-� g�A i
Submittal Fee $ Permit Fess
Scanning f ee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO/CC $
DBPR $ Bond $
Technology Fee $
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
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
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 bd�pproved and a reinspection fee will be charged
Signatur_ l�/6�ii Signatu
/ re +
a
Owner or Agent Contractor
The foregoing instrument was acknowledged before �meathis
day of 20 /Jby
who is personally known to me or who has produced
Tan �aust As identification an61'§k EZ
NOTA R UBLIC: NOTARY PUBLIC
STATE OF FLORIDA
Comm# DD967572
o:.._.a ices 3/3/2014
My Commission
The foregoing instrument was acknowledged before me
day of Al 20 4f), by 01746�6 '
w®®ho�, is personally known to me or who has produced—EL—D-4054"
0(4' A 9 ° as identification and who did take an oath.
NOTARY PUBLIC: GISELLA MARIA SANCHEZ
NOT Y PUBLIC
STA OF FLORIDA
DD967572
Si
My Commission Expires:
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)