RC-14-1124Miami Shores Village
Building Department
90050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
1-0
j I!D l"- i FBC 20 �o
UI DING Permit No.
PERMIT APPLICATION Master Permit No. 2,�
Permit Type: BUILDING ROOFING
JOB ADDRESS: x'10 3 S n' C
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes NO V" Flood Zone:
OWNER: Name (Fee Simple Titleholder): N 1 V K O44 T:^ t/2$Tm e v +S Phone#:
Address: Zt S O W• 10 -%%ft Q. V ,e.,
City: _ 14 f Q t ea h State: IR— Zip: 330 / O _
TenanULessee Name: Phone#:
Email:
CONTRACTOR: Company Name: & ec a V% S; ,n e 2 r e A- o Phone#: 30-C C t 9' '43'7 (
Address: Z t SO W - % V t Ca ill_
City: K f& ( tr4 k State: ire► Zip: 330 f C
Qualifier Name: fav X j 1 1 1(, vA Z, t i,� .Phone#:
State Certification or Registration #:
8`79-7
Contact Phone#: 30 S — 'Z l 4 v PE& 1 Email Address:
of Competency #:
OL P[.. lal 4 /x'14 e 1 - o 0.q
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 6' d D 00 - Square/Linear Footage of Work:
Type of Work: ❑Addition f�lteration ❑New ❑Repair/Replace ❑Demolition
Description of Work: (Ler90v e. a n,4 iL e p (QG a �h l d 4 i i -c o a m t o ,.t d 0 471 AS _
0^6t &,e &cc_ 1,2 t- tn N e vj e,o wn p o w e r a nov-o a 0 4 r At c+ 07
w ell t-F'�.r► ly "'o r_1
Color thm tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Notary $
Radon Fee $
Training/Education Fee $
DBPR $ Bond $
Technology Fee $
Double Fee $ Structural Review $
TOWAL 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 be approved and a reinspection fee will be charged.
L
Signature Signatu
Owner or Agent Co actor
The foregoing,instrument was acknowledged before me this The foregoing instrument was acknowledged b fore me _this vA
day of -,�S �, by 710 h Ar 14 �icc�- , day of 79' , 20 �, by V ` 01(?A , I�
who i XEonally know me or who has produced _ who i ersonally know me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
SR1VDY ROMERO
•° �M Commission # EE 116040
1 My Commission Expires
APPROVED BY
7h
Plans Examiner
Structural Review
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/150))
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
'ueb rMiWbW* EE116040
My Commission Expires
"•%;;�; ; PF July 26, 201 s
Zoning
Clerk