RC-13-1677 (4)Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
c
AUG 19 2094
BY:
Ric-
2010
BUILDING Master Permit No. VBG -4" 13- A F7
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
r k
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
�•CONTRACTOR DRAWINGS
JOB ADDRESS: q53 5- � � � 4 S
City:. Miami Shores pp County Miami Dade Zip'3 3 ( K*E'
Folio/Parcel#: 1 1 ' 3Z-®4 - oI4 ° 2-3 b� Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: NC) BFE: FFE: -�
OWNER: Name (Fee Simple Titleholder): IL(r syri-{--I?'[�- phone#:3c�s-- q6 j ' �� /
Address:A (.S N S �
City: , T qq State• Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: ®9-0 �-k 1d'Phone#: ?6F.
Address qb met, t NX v,( rT- �� p
City: o—k State: I- (— Zip: _33(6/�
tS
Qualifier Name: (DAW>d`-30 Phone#:
State Certification or Registration #-C&-) 7-5-16 K -H Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State Zip:
Value of Work for this Permit: $-3;po c Square/Linear Footage of Work:
Type of Work: ❑ Addition Wkiteration ❑ New Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ 00 CCF $ CO/CC $
Scanning Fee $ 6 Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
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
Zi
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.
s
Signature
0 R or AGENT
The foregoing instrument as acknowledged before me this
-q day of 62 G -" Sl— 201, by
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
( i� day of &Cry 20 1 L by
y ii-UA-rn1 , who is personally known to �`�rcx,/> � ss��S -,who is personally known to
me or who has produced kn A, h U:� as me or who has produced C3N �'l L� as
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal:
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
REBECA M. PASTRANA Seal:
MY COMMISSION # EE872b24
EXPIRES: Fehntoy 07, 2017
APPROVED BY Plans Examiner
Structural Review
(Revised02/24/2014)
W,
REBECA M. PASTRANA
MY COMMISSION # EESM24
%vw t EXPIRES: Fd maty 07, 2017
Zoning
Clerk
8/19/2014 Property Search Application - Miami -Dade County
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