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PL-14-2101 Miami Shores Village I Fi . , 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 FBC tt2a 0t, , BUILDING Master Permit No. 1� ` � PERMIT APPLICATION sub Permit No.PL`- 14, 2A d ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP //�� CONTRACTOR DRAWINGS JOB ADDRESS:/�[/ 7 /1/ 11 �,% City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: !Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): G SC� f [S' s/L t� Phone#: Q y Address: �� /� 02 � r O/�S / City: �i41 Mr State: � Zip: 331..?pp Tenant/Lessee Name: Phone#: Email: '/ 1 CONTRACTOR:Company Name: /��p `p�?ST/GfG�iOr► � �[ Phone#: 2 9YY—r?-� Address: 4611/ Nw C 73 /� f c City: /�liA �� r�CrS State:�T L Zip: 2314 7 Qualifier Name: C r �"�t / o�(ol e,- Phone#: .SOS 2yy 917P State Certification or Registration#: I, g�� Certificate of Competency#: DESIGNER:Architect/Engineer: phop # Address: City: State. Zip: Value of Work for this Permit:$ ©0 a uare/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition Description of Work: eA/ A'" �" AeS'i✓' �1 i Specify color of color thru tile: r Submittal Fee$ Permit Fee$ �s " CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$0 TOTAL FEE NOW DUE$ (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address _ City State Zip Mortgage Lender's Name(if applicable) Mortgage Lenders 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. r � Signature Signature 0 NER or AGENT CONTRACTOR The forego g instrumen was acknowledged before me this The foregoing instrrgent was acknowledged before me this day of /1 Gt`)u S 20 /!Z . by �day of3" t!-s"7 20 ��/ by i nn ,who is personally known to r°f rI//� jr who i ersonall know 0 ll�" me or who has produced ir✓e" G,Certf e as me or who has produced r as identification and who did take an oath. identification and who did take"an . NOTARY PUBLIC: NOTARY PUBLIC: �� Sign: � Sign: Print: J e Jet rtS Print:... j4m (>° e-In In S Seal: Seal: JAMIE JENKINS JAMIE JENKINS MY COMMISSION#FF009945 MY COMMISSION#FF009945 EXPIRES:April 21,2017 EXPIRES:AprH 21,2017 APPROVED BYPlans Examiner Zoning Structural Review Clerk (Revised02/24/2014)