MC-13-1462 . �� JINN 2
Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
BUILDING Permit No. LN�UoI
PERMIT APPLICATION Master Permit No.GAG 6131253
FBC 20/v
Permit Type: MECHANICAL
OWNER:Name(Fee Simple Titleholder):F, n�� , l���� L� Phone#:q4 dX/A . q 3 n
Address: 4�Pc)1 16� G1,dM&05
City: �M'i FA State: >a4 D'a Zip: 3&6 f'!7
Tenant/l essee Name: Phone#.
Email: �U �,�� Aa
JOBADDRESS: /3 T NW S 7
City: Miami Shores County: Miami Dade
Folio/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
CONTRACTOR:Company Name: l�'l C Go N 72A�-��25 , Phone#: 305�9? IAV 3
Address: /t 2Go 1 1/U5 A.0
(�.0• —
City: ^1'0'M4 8 e0,6 A State: �L b Q Zip:
Qualifier Name: Phone#:
State Certification or Registration#: C G 19 LS 16Z Cem J�&ncy#:
Contact Phone#: -9a3 Z�13� Email Address:
DESIGNER:Architect/Engineer: P
/ Phonek
V
v
Value of Work for this Permit: Square/I3near Footage of Work:
Type of Work: OAddress OAlteration JdNew ORepair/Replace ODemolition
Description_o£
STA Ne-w rgeekasSAr i ,mow oLcr wou<.
Submittal Fee$ Permit Fee$� CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notar Training/Education Fee$ Technology Fee$
Doable Fee$ Structural Review$
TOTAL FEE NOW DUE$
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 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.
Signature �–� Signature—7
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 5�i�e ,20 /3._,by C,SeM*« day of .5 use ,20 1 ,by'662x•r FZu-> >A'�J
who is personally known to me or who
,�has
dproduced tJtiue4 td e- who is personally known to me or who has produced,_,,,,
,stPpr P(' i pAaj° 'A� c&81an oath. as ANOTARM
""�`` PAULA E. CASTELLANO
.........
NOTAR MY COMMISSION#FF001595 MY COMMISSION#FF001595
" ``• EXP ES March 21,2017EXPIRES March 21,2017
•0 idallotaryService.com ��-0FloridallotaryService.com
Sign:Print. V Ae l 9
My Conumsio pires: My Commissi n Expires:
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(�Q-
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)