EL-14-2426 Miami Shores Village
uilding Department SCE D
0 0 N.E.2nd Avenue, Miami Shores,Florida 33138 APR 2®15
Tel:(305)795-2204 Fax:(305)756-8972 BY:
INSPECTION LINE PHONE NUMBER:(305)762-4949 -
FB OI
ILDING Master Permit No. RC,'" 10
PERMIT APPLICATION Sub Permit No.
❑BUILDING XELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS [:] CHANGE OF CANCELLATION ❑ SHOP
f r CONTRACTOR DRAWINGS
JOB ADDRESS: 3S4g IV'E . gyn J c�1 �eyr c
Com: Miami Shores County: RL Miami Dade Zip: �c'J
Folio/Parcel#: Is 3c12-0p® 1 F2� 1 ® Is the Building Historically Designated:Yes NO
Occupancy Type:SQj'Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): JONM 11L� C• VJ��i�"�/nav� Phone#:
Address:_ mg N•e - R4 I rl s V2x-l-
City: I6 ft' 5e",5 State: ��' Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: �`C� Phone#:
Address: ld- A&- Z41 S
City: Gr p State: Az_ Zip: 3�130
Qualifier Name: rry-P_ Phone#: `fid-®m
State Certification or Registration M qq-3 2 Certificate of Competency#: IaE-b( eop f 2
DESIGNER:Architect/Engineer: FLw'i Dt� i `O N'qt_ '016j Pone#: � 3
Address: 00 N.W® "MR 7-4�?Ef/ 501t-laity: {i1m a State: Zip:-';::�/2-2
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration` / _E1 New ElRepair/Replace ❑ Demolition
Description of Work: u6lrl� '4&kms AS SAzq_ue- [Pl fa (�
Specify color of color thru the
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ oe
TOTAL FEE NOW DUE$ "
oo
(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.
Signature Signature "'�L
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 ,by day of ,20 L3 .by
who is personally known to �7 �C( ,who is personally known to
me or who has produced- "Dc ki/C-P'-� U&EI,5�& me or who has produced LM-�C—E �aQJ:N as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
Seal: =Puo � tata c Florida Seal: cr v Notary Public Stats of FiorldaA z ;P SIndia Alvarez
n FF 156750 �< My Commission FF 156750aoe2018 a', Expires 08J0312018
x� a �k�x*t��o �x*�e#�k�xx���x��x�x�*�x�xx�*
APPROVED BY YAAoo� /6 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)