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EL-15-850 (3) Miami Shores Village cxN' +:, ^ Building Department APR Zo,S 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 �b BUILDING Master Permit No. ]7C-`/ '—) A�� PERMIT APPLICATION Sub Permit No. RL-15-8m BUILDING 0 ELECTRIC ❑ ROOFING REVISION EXTENSION RENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 171 NE 102nd Street City' Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-3206-013-1840 Is the Building Historically Designated:Yes NO X Occupancy Type: Res Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):STEPHEN C MUMBY&ALBERT V CATTERTON JTRS Phone#:786 464 9360 Address:SAB City: State: Zip: Tenant/Lessee Name: Phone#: Email: 430steve@gmaii.com CONTRACTOR:Company Name: L©n/-/'l a"' Phone#: 305',:23,0 J A!l Address: D �^� City: �, 5 h���Sj J/ State: !' Zip: 3 3 3 8 Qualifier Name: /1/KM 9n/ Phone#: 30 f, ?.`,0 State Certification or Registration#: 1� 3 ey 3 71,� Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: ^ City: State: Zip: Value of Work for this Permit:$ d 1 3 © Square/Linear Footage of Work: Type of Work: ❑ Addition 0 Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: ►'i 1,1�fi��n� i 1 C-/h Q-We l Specify color of colorthhr�ru tile: Submittal Fee$ Permit Fee$ 2-ZiT m® CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 92 16 (Revised02/24/2014) h Bonding Company's Name(if applicable) Bonding Company's Address — City State Zip 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 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 o attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection hlph occurs seven (7) ys after the building permit is issued. In the absence of such posted notice, the inspection will not be a pro an einspe ioh fee will be charged. Signature Signature OWNER r AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this r day of p)-i 7 120 by )3 day of Ale f�'� 20 15 by hr'iy /y1( y�,who is personally known to J"L1*Lb!qe 1 Ly,i/.tn2�who is personally kr�oautto me or who has produced T as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: /�/► Print: Print: 7"1 1• L e �e!°e— Z• -Or"4V Notary Public State of Florida Seal: ;4 `f` Michelle Perez Seal: u My Commission FF 000321 WP Notary Public State of Florida oFF`o� Expires 04/08/2017 Michelle Perez My Commission FF 000321 p Expires 04/08/2017 APPROVED BY c �n Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)