BPP-14-1574 aliami Shores Villages c VE"D
Building Department artment JUL 2 2 W4
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: 305 795.2204 Fax: 305 756.8972 LBY'
INSPECTION'S PHONE NUMBER:(305)762.4949
5 �js FBC20d0
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.j
Permit Type: BUILDING ROOFING
JOB ADDRESS: Iva r gr, C%-L st.
City: Miami Shores County: Miami Dade Zip: 33\3b
Folio/Parcel#: Il® non- ®2,4' o3®)
Is the Building Historically Designated:Yes NO X Flood Zone:
OWNER:Name(Fee Simple Titleholder): 1.ftu,%L*\VL 'Q9WWP4 S&IftC.e3%C Phone#: 3�• `\•6 �'
Address: %22 r Ne C,,t S}
City: %C, fe.S State: F` zip: 33\S%
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: �ot�S FL• -AL Phone#: 3US.2C Q•4tS~S_5_
Address: ll4ltO Sw M16 5\- 1 ILI .1 n
City: 1 A\AM1 State: FL`i
Qualifier Name: LAI �*o®- Cave,.�e � Phone#:
State Certification or Registration#: U ..%4 0'O-CS' Certificate of Competency#:
Contact Phone#: 305'• LL 0 ,4 SSS Email Address: �o ® C1 C h►epoD�S Corn
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑Addition ❑Alteration ❑New �epair/Replace ❑Demolition
Description of Work: S%.i..rnvq6�6!� c.'ndc� d� c�c
�Ae.J Sv:,nnw�',N. oo\ VG\c(�:re a�\� + �� \a.►\\most ro,�;r�T••��pc.Je.r-
���CAUt�`
Color thru tile:
Submittal Fee$ •� Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ 00
1
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 ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 comment m1ent and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certifiedc p�of the,recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after tfiebuilding permit is issued. In the absence of such posted notice, the
inspection wi t be approved-ant reinspection fee will be charged,
Signature Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this z The foregoing instrument was acknowledged before me this Za
day of 4 20 tA,by SSC. day of �k -1 .20� ,by U-1 tk -roc-
who is rsonally known to me or who has produced who isersonally known to me or who has produced
identifica'o d who did take an oath. as identification and w o did take an oath.
NOTARY PUBLI NOTARYPUB I
Sign: Sign: J
Print: . Print:
My Commission Expires: °`+'T�`1: G<7RIK E.OUARDIA My Commission Expires:
N t . AM.ION#FF 030387
July 4,2017
Uunded i hrj Malay Pub;C Und9eYrt terB a° �f#g' GABRIEL E.GUARDIA
s*. My COMMISSION#FF 030887
fid ®® sd Thru ry PUM Undewbrs
APPROVED BY Plans Examiner ning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
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FEB 11 2615 �
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