RC-14-1096 Miami Shores Village F014
EIVED
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ;^
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
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BUILDING Master Permit No.
PERMIT APPLICATION sub Permit No.
(BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
F-]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: IL-1-to f N l rn S���
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#: I - Z� v S �J31 0 3 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone:A� BFE: ^� FFE: d
OWNER: Name(Fee Simple Titleholder): Y" ' �-C L I T Z EN 06L Phone#: S 3 6 S r
Address: I L4'ZO fes'(.
City: M /4-1( i /1,'I�-f s ��rL� Zip: l 3
Tenant/Lessee Name: Phone#:
Email: n
CONTRACTOR:Company Name: Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGN :Arc tec ngineer: VoAw'c A- CA'VOY3 rZ L PhoneM
s: City: State: Zip:
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Value of Work for this Permit:$ L 06, ooq Square/Linear Footage of Work:
Type of Work: ElAddition ❑//Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: P,/�� \2� � ''i P'("10r'l U'& m'-" Cl zoZ-6
F� S7 Nom, fkuA cf- "y w ✓s L- P C-t-1 A4-]
Specify color of color thru tile:
Submittal Fee$�:ZCDQ. CXD Permit Fee$ 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 wi timated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement and capsrdtion lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the r e notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the buildi mit is issued. In the absence of such posted notice, the
inspection will not be approved and a rein1pection fee will be charg
Signatur Signature
OWN CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of rVNPr-c J20 M by day of .20 by
M N(2J-- Qq S4P4X'+�', rho is personally known to ,who is personally known to
me or who has produced 1k L t� as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
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Sign. _ Sign:
Print: Print:
Seal Seal:
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APPROVED BY Plans Examiner ce ( / Zoning
Structural Review Clerk
(Revised02/24/2014)