ELC-14-2753 (3) Miami Shores Village ,\- _
Building Department JUL Zo M
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
_ Tel. max. -8972
ErV
IiNS
Oio%3115)762-4949
FBC 20-1-b
BUILDING hiaster Permit NO.GC.-I -1A--b'S
PERMIT APPLICATION sub Permit No. -LI-'14- 27 -3
❑BUILDING ZK ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: it 32®Coo 13 74 Q Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder):4 611'Z!� 00 :206- UX— Phone#: Lb')
Address:qq It—_'39-, 1JG l(424.q_. 11
City: Yv. fol, l3 State: C— Zip: �'311®t
Tenant/Lessee Name: Phone#:
Email: "VA?_6tQeLa„ 6-RINLIN11.
D
CONTRACTOR:Company N me� � �aw � f
Phone#:
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Address:�31sm 5U) l to
City:fi t State: rs-L Zip:,33 31 Z
Qualifier Name: A 3,0 L46. Phone#: �,2
9�j
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 3� Square/Linear Footage of Work:
Type of Work: ❑ Addition &Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: j' 000 0 5 3' LI,44n -PA.) 6DO ,cod
squpwv SAS
Specify color of color thru tile: vvt,,..
am
Submittal Fee$ Permit Fee$ CCF$ /C
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ q
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Z Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State Zip
e
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 conditio to the issuance of a building permit with an estimated value exceeding-$2500, the applicant must
promise in goad faith that a cop of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to att chment. Also,a certified copy of the recorded notice of con encement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In he absjehce of such posted notice, the
inspection will not be appy v d and a reinspection fee will be charged.
Signature Signature
CONTRACTOR
The foregoing instrumtNERorAGENT
was acknowledged before me this The foregoing instrument was acknowledged before me this
(3 day of "CC,e� ,20 IS- by day of U ;ql/t .20 1 .by
CoZe DA-lr ,wh is personally k ¢ �� /Zts(/Q— ,who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath4#FF123,ao"•P(js"•.,,
NOTARY PUBLIC: NOTARY P �� GELKA A
MY COMMISSIONEXPIRES Se temPSign: Sign: (407)39"153 Florldallota 5e
Print: d Print:
Seal: „w
Mike Va qui Seal: _?;<�!`^�., GELKA ACUNA
z*
t8My {€ MY COMMISSION#FF155823
WVdM JVAWY 15.211119 fid?•` EXPIRES September 1,2018
l�18r*y rvice c*o*m*
APPROVED BY ✓ /d�—��'� Plans Examiner Zoning
a
Structural Review Clerk
(Revised02/24/2014)