RF-14-2074Miami 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: (305) 762-4949
FBC 20 10
BUILDING Master Permit No: - �
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: V� �9 �( � �
City: Miarrai Shores County.. C If Miami Dade Zin- 33 )
Occupancy Type: Load:
OWNER: Name (Fee Simple Titlehold
—6)/ io — (-,-) Is the Building Historically Designated: Yes NO
Construction Type: Flood Zone: BFE: FFE:
Ali/ILS 9 on_��-O 4 _ IV Phnn"-
City: , Q c, State:
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name: P\0 D P%j W 6N 62P.41 P �6� hone#: r 74 6,75A 7,1
Address: 2.� CCS �) 5 4 /
City: ►g!� 1 d �.g 1 State• r/ Zip::
Qualifier Name: I -Ac ztv A ij �� C ��a Phone#: Vi .30;1-56_q%
State Certification or Registration #: C G is A67 Y -Z/ Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $
Type of Work: ❑ Addition
Description of Work:
t
N
State Zip:
Square/Linear Footapwof Work:
Alteration ❑ New Repair/Replace ❑ Demolition
rf✓ Pa c n rte, i /—., _
Specify color of color thru We:
Submittal Fee $ ° 00 Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
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
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 gapproved nd reinspection fee will be charged
Signature .� Ao Signatu
OWNE or AGENT CONTRACTOR
The for,egoiinstrument was acknowledged before me this
day of 20 by
V', 3 Cv,—C-- W% whb is personally kn wn to
me or who has produced
as
The foregoing instrum t wa�cknwledgecl before me this
day ofr 20 by
who is person Ily known to
me or who has produced r7V\,:2,_ s'\ &2--Z7
identification 16i_ agr, _ _ identification and who did take an oath.
ntUbSA RAMIREZ
Public - State of F
Sign:_
Print:
Seal:
APPROVED BY
(Revised02/24/2014)
Sign: e 8 LVA
' il ryP Iic t t Flori
Print:
too*
Seal %;"���°:��- Coialmissian 0 FF 133992
Plans Examiner Zoning
Structural Review Clerk