RC-14-1717 Miami Shores Village °b ¢
c�
�� � Building Department ,�; Y
0 5G \ �_(�, 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(30S)762-4949
FBC 20
BUILDING Master Permit Nolo.- 41
PERMIT APPLICATION Sub Permit No.
OBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 50/ 'k)& qa S
City Miami Shores County: Miami Dade Zip:
Folio/Parcel#: //— 3 3o(o ®/7— /S-�y Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: tj t-2) Flood Zone: "-"7' BFE: FFE:
OWNER: Name(Fee Simple Titleholder): �7 ^� (7�IPJ[� Phone#: 7S (4) x/37
Address: ,/�Y f� ��d //S �D
/
City: /`� � /"/'q m/ Sta ff Zip: ss/&/
Tenant/Lessee Name: Nkl Phone#:
Email:
CONTRACTOR:Company Name:,%0)/11ole1.0,l&1s/-&C run l aacl,n -7 v" Phone#: /, f o
Address: -23ou t y7t,14,-JrC, 731,/
City: ionn20 State: TG- Zip: 33o62-
Qualifier
3o6iQualifier Name:IkTL2Phone#:
State Certification or Registration#: L 6C I513073 Certificate of Competency#:
DESIGNER:Architect/Engineer:_/fii✓ �o�+A �N��N�°P/L�S Js e-�NG Phone#: "(oil? —G 65—/
Address:.J' 5 - �. /rnn�p /o / ky City: f 0yn�faNA State: zip:
Value of Work for this Permit:$ Square/Linear Footage of Work: '' o®0
Type of Work: ❑ Addition Alteration ❑ New [�14epair/Replace ❑ Demolition
Description of Work: _14LTCR4�111Od Ok f f' � ,� {ti.t�,•� � t ^,e (' t � f�%�
�'l Y'+E--2' C �,t.`_..�; �-� \ 1.'�'�k'"'�'.., ( �'..,-�"'S. :S('0,� 1'`. �(�L"�Ci A.-^^a > f �"� 'F',� 1.°.1 °t'_.�,.C31,.�(; •.'� J
�T
Specify color
��o(fcolor thru tile:
Submittal Fee$ 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)
t
Bonding Company's Name(if applicable) _ WIA
Bonding Company's Address N/�I
City State Zip _
Mortgage Lender's Name(if applicable) �/A
Mortgage Lender's Address_ Ljlf1
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 b 1t ' it with an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of comm struction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy o c d@!d notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building "Is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee wil e charged.
Signature Signature
OWNER or AGENT CONTRA R
The foregoing instrument wa cknowledg before me this The foregoing instrument was acknowledged before me this
day of �°'' 20 ,by day of 20by
( 6 G' ,who is p ally kn to r ' t t`� G 0
' who is rsonally know o
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who id take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: K421 -r! Print: 11,aezoo
Seal: .��'� PETER J.KOLOSVAR Seal:
►�'4
MY COMMISSION N FF 079590 +�'"
"'4;` MARWAN EID
a EXPIRES:December 26,2017 "': *; MY COMMISSION#FF134002
'''/ Q$•' Bonded Thru Notary Public Unden+dters iiu�.. ,-`
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{407)398-0153 FloridaNOWYService.com
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)