DS-14-2379IVlldl I II JI IUI CJ V IIIdgC
Building Department
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
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
(7�Ir ��
OCT 2 6 2014
F:_ -
FBC 20'LU
Master Permit No.i-12-13-27'15
Sub Permit No. ID5 M
Rf REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [—]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 295 NU c16t' ST�i iT
City: Miami Shores County: Miami Dade Zip: 331bb
Folio/Parcel#:1132!!QW133970 Is the Building Historically Designated: Yes NO ✓
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):AIwN LOtMrwbyS Brf oiilim Phone#: 306% 12690
Address: M Nt 415'" STAT
City: M�Ogry i6yiCKWiS state: 11• zip: 331'b?)
Tenant/Lessee Name: tyAr • Phone#:
Email: A�ISOI/��d Qy11�s'rArlrltre'L.COI'Y�
CONTRACTOR: Company Name: S64"M CoftTyWrIoN 6EWMS Phone#: 3% 1577 0I!50
Address: 71 I'1% SV4 4-1 {~ ST. W11C 6
City: 10~ I
Qualifier Name:
r_L– zip: 5—'-N 5b
Phone#: (,Too j7r' !rf z
State Certification or Registration #: K6 151060 jQ Certificate of Competency #:
DESIGNER: Architect/Engineer:yeyo9'1 IC Phone#:
Address: "/I?/ 4GJ 7 V/.A e-1 City: /%19M•I State: rl Zip: 3j�ls�
Value of Work for this Permit: $ 3-00 Square/Linear Footage of Work: 24a
Type of Work:
❑ Addition ❑ Alteration ❑ New EK Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile;
Submittal Fee $ Permit Fee $ CCF $ (3 _hr CO/CC $ was
Scanning Fee $ Radon Fee $ DBPR $ 2—Notary $ 5�0
Technology Fee $ Training/Education Fee $ t -!2 Double Fee $�4�
Structural Reviews $ Bond $
TOTAL FEE NOW DUE S C04-60
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
A
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.
Sign atur Signature
O ER or AGENT CONTRACT
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
2-1 day of OGTCeCR. , 20 14 by a day of QT06151L 20 14 , by
&A50hl AWK161916 , who is personally known to M -D (A -A. , who is personally known to
me or who has produced F3L^ ID as
identification and who did take an oath.
NOTARY PUBLIC:
me or who has produced
?U 1D
identification and who did take an oath.
NOTARY PUBLIC:
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Sign:
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Sign:
Print: Cil/l M A
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Print: CA
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Seal:
Seal:
CLAUDIA L PEREA
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CLAUDIA L PERE...
MY COMMISSION #FF120051
MY COMMISSION#FF1P(r�'•
,
05
EXPIRES May 6, 2018
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EXPIRES May 6, 20 , ,
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APPROVED BY
Plans Examiner
Zoning
Structural Review Clerk