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PL-14-1143 (2) Miami Shores Village BuildingDepartment p JUL 2 2 205 0050 N.E.2nd Avenue, iami Shores, Florida 33138 5 2 Fax:(305)756-8972 10 I NUMBER:(305)762-4949 FBC 20 1© BUILDING Master Permit No. PERMIT APPLICATION ub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL [PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP . I CONTRACTOR DRAWINGS JOB ADDRESS: -5 2 (�E �(� S�11�� 4- City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:\\ 5166 0 la kyr 0 Is the Building Historically Designated:Yes NO / Occupancy Type: Load: Construction Type: Flood Zone: 100 _BFE: FFE: OWNER:Name(Fee Simple Titleholder): IttiC "O; AhOuoS\4- Asaxk j- Phone#: Address: 5 - NLS -- City:VUQAAll State: 1—L Zip: k3a Tenant/Lessee Name: Phone#: - - n Email: CONTRACTOR:Company Name: !j t`1V `S��vw��i ��S�,2v t C-� Phone#: -6 OS' a Z S'X1333 Address: \�3 vJ ��`�L S p\f City: i V�`Ae`va.�1 State: L Zip: 33 V 2 Qualifier Name: Phone#: State Certification or Registration#: C C^ 128 (, Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ i bb' Square/Linear Footage of Work: Type of Work: ❑ Addition [�r Alteration ❑ New Repair/Replace lRe air Re lace F-1 Demolition Description of Work: wyAer Y� `- , ^ o-� e4-n Specify color of color thru tile: Submittal Fee$ Permit Fee$ J�5 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 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. 01 Signature Signature ----0 OWNER rAGENT CONTRA OR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 22- day of csl 20 IS— by 22 day of 6' 20 1S by �A:0. k*XCuyy, 0. ho is personally known to I Aont�� -1'�f who is personally known to me or who has produced�� rt�`�,? as me or who has produced 0,A R2 as identification and who did take an oath. identification and who did take an oath. NOTARY-PUBLIC: NO Sign. G/ Sign: Print: a �. Print: AQ Seal• Ily P14-1b Seal: R 'EBWM.PASTRANA PO*0,00 % REBECA M.PASTRANA 'AnMyCOMMISSION RE_S IFslebruary 07,20174 MY COMMISSION#EE872624 EXPIRES:February07,2017 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)