DEMO-14-1146 Miami Shores
Village �
Buildin De artment JUN 03 2:014 '
g N BY:
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 20
BUILDING Master Permit No.pff XY10 I t-j-- I ) 49
PERMIT APPLICATION Sub Permit No.`�-yyly 'l - 11 Il1(tc,
F-1131.111-DING ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLICWORKS ❑ CHANGE ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: S2 S' n%k) i 1 I 4
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): CA -&-C— V A Phone#: 30®-. 43FN IZ i
Address: SZJ OW Ilk 1;;i-- -
city: --Lid 11 -IGI'l Ori `9� State: Zip:
Tenant/Lessee Name: Phone#:� ' 3—
Email:
At
CONTRACTOR:Company Name: At o n#,- lorl f"pp
�mrRI a CoRp Phone#: 766-417 9161
Address: 10152 $W 119-5 CT
City: M IA041 State: ��' Zip: 3M 53
Qualifier Name: (" U eo HIS Phone#: qB&-417 5161
State Certification or Registration M i0 E000(oSq Certificate of Competency#:
DESIGNER::Architect/Engineer: <::'�C) Phone#: ®ib- --740Address: k9_®(& CPH-nAp Wil® ox City: CCXIAAZ—C State: 2 Zip: 3? f
440
Value of Work for this Permit:$ 1 Square/Linear Footage of Work: �� -
Type of Work: El Addition ❑ Alteration ❑N-_��;.,,�,r c [1LDemolition
Description'of Work: � rQ4_( �' <, ►�a'n
r
.. r 4 nolaa�o5
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ /1_c�,crnz, CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$_��� U
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 fait a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose prop is subject to att ment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the .st inspec ion which occ s seven (7) days after the building permit is is d. In the absence of such posted notice, the
ins tion will n be approved and a reinspection fee will be charged.
Signatur Signature
her or Agent ontractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me
� al k S
9 L t..�tc
this da of � 1 20 � b c�¢.�.,torrt. da of � 2 20 b i 5
Y � Y Z.�.�.1�.e�- Y � Y
who is pe r��to me or who has produced who is personally kqSIW t me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBJJQ
Sign:. l n
Sign:
Print: ��S Print:
ANIDM 0102
My Commission Expires: Nfty per'staof Hafda My Commission Ex f�'y
My Cm".lhgt S"21.2015 CMWYIY IAI ARELLAj
C +5 E2132342 80
EXPIRES:May 26,2017
eonQgtl riw Nosy I U-0 Mhanufm
APPROVED BY _ . Plan Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012))(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)