DEMO-14-213 r q lvilallll 011V1 Ub r 111C1gG
Building Department FEB 0 4 2014
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 :
Tel:(305)795.2204 Fax: (305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20
BUILDING Permit No.
PERMIT APPLICATION Master Permit N Oe-MO l'l U'2l3
Permit Type: BUILDING ROOFING
OA
JOB ADDRESS: TO Q N IUD l
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder):2 t .1.5 a "tom
Address: `7ao NE to D 5T
City: Yj ia.l'Yl I Sh[(.e�_State: Pti Zip: 33 13
Tenant/Lessee Name: Phone#:
Email: ri'YIGL .e0 70 jpG
CONTRACTOR:Company Name:� Qe Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
Contact Phone#: Email Address:
DESIGNER:Architect/Engineer: �1l' U a�P S Phone#:
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Value of Work for this Permit:$a6ftuomm Square/Linear Footage of Work: c_2-0 0
Type of Work: ❑Addition OAlteration ONew ORepair/Replace 115emolition
T0
Description of Work: / t
C�1,L1�&-0 � �?.Qi lJ�l2i'ls �S� El'o rJ r
Color thru tile:
Submittal Fee$ Uv Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL,FF.F.NOW DIJF.$
Boiling 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 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 a building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee w ed.
Signature
Owner or Agent ye8A Contractor
lyV
The for�going instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of L&baf
q-,20!-V,,by �2 (d�I Slif��d' day of ,20_,by >
who is personally known to me or who has produced H3 Gb M who is personally known to me or who has produced
(7 _l 9/s'-o As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
t; rida Print:
° 1' JoannaLliciano
My Commiss' qre : My Comn FF oe27ss My Commission Expires:
prgo� Expires 2018
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)