RC-15776 Miami Shores Village RECE
Building Department APR 2015
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 B
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 (� r
BUILDING Master Permit No��^ J
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1 '�U NUS LO 4 5T.
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11 a13 6 013 1 S OU Is the Building Historically Designated:Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):�'tQ GI 5[o Q J!� i EZ' Phone#: 7��`c:?O0 O 3
Address:
City: V_ (l m[ ISVAE70E�:s State: ip: ✓3 1Sy
Tenant/Lessee Name: Phone#:
Email: l 4 Jt NON45_z`j SuL ,o. C_C'm.
T
CONTRACTOR irCompany Name: Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: ll Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work: W
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: 3aAhYOO to
Specify color of color thru the:_ may
Submittal Fee$ `' Permit Fee$ CCF$ CO/CC$
Scanning Fee$ 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 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 YO
YOUR NOTICE OF COMMENCEME DER OR AN ATTORNEY BEFORE RECORDING
/ i
Notice to Applicant: As a condition to the iss fa 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 ttachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection whi occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approand a reinspection fee will be charged.
Signa e - —- Signature
- OWNER or AGENT CONTRACTOR
The foregoing instrument
/was acknowledged before me this The foregoing instrument was acknowledged before me this
lJb day of /H Cn' 20 I by day of 20 by
� (�SCO C� V.�►�I �o is personally known to who is personally known to
me or who has produced 'Fl- `CIF � 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:
Seal: Seal:
"ftp Notary Public State of Florida
Sindia Alvarez
A� My Commission FF 156750
Nor p Expires 09/03/2018
***************** * **********************************************************
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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ADD SMOKE/CARBON MONOXIDE DETECTORS. 9 I c a
ANY AND ALL CLOTH AND RUBBER ,,, „•
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INSULATED CONDUCTORS TO BE REPLACED. ' ' •
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