RC-15-1049 Miami Shores Village RFcErVE
Building Department MAY 04 2015
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
"\ �A FBC 2010
BUILDING Master Permit No. d`?._ h57__ o®Z�?
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL E]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
��gg�n' !;� CONTRACTOR DRAWINGS
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JOB ADDRESS: 13 N Wi 17 1-h �V�
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO x
Occupancy Type: Load: Construction Type: Flood Zone: BFE: / t �1FFE:: U
�OWNER:Name(Fee Simple Titleholder):. � �5 0 ( Phone#:
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Address: Ann,
q/ "1"
City: f"I n n, res f c L- Zip:
Tenant/Lessee Name: 11/1, Phone#:
Email: '
CONTRACTOR:Company Name: T A kr® CiMA 1.e®Al Phone#:
Address:
City: State Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: AJC ; ec6fa l ('(0UP JosveA"C{td2 Phone#: 361-773"S �I
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Address: J7 06 (o� City: •►;grin r State: f L Zip:
alue of Work for this Perm :$ �� �� i uaro/Liheaf 1 to f�Alork: 10D
—� M
Type of Work: ❑ Addition ® Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Keel'Ru asct " je f( ' Del q ('V?'ddb1J$ r
aC8 0 nv Wi a � t. A ee ® s 6V ;
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Specify color of color tghru 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)
Bonding Company's Name(if applicable)
Bonding Company's Address
I
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:'
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Notice to Applicant: As a condition to the issuance of a building permit with an aN�e exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement and c /a w, irochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of tl e of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the bui ► ' it is issued. in the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charge .
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of20�, , by day of ,20 . by
who is personally known to ,who is personally known to
me or who has produced o^nC_.. 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:
Si Sign:
Print: Print:
Seal: aav p��. Notary Public State of Florida Seal:
Joanna M Feliciano
nAy Commission FF 082753
Expires 01/12/2018
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APPROVED BY � Plans Examiner -� 3 d Zoning
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Structural Review Clerk
(Revised02/24/2014)
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Notary Public State of Flow
Sindia Alvarez
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My Commission FF 158750
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