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RC-12-1016 (4) 4�� g Miami Shores Villagen. v LoullcleanDepartment SEP 11 2015 O' ' CTM7 ue,Miami Shores,Florida 33138 2204 Fax:(305)756-8972R t: V ONE NUMBER:(305)762-4949115411FBC 201'A BUILDING Master Permit No. PC_/;2 — /0/6, PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING 21REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 5 Aj Yl) W2 City: Miami Shores County: Miami Dade Zip: ��I Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction CType/: Flood Zone: BFE: FFE: �+ OW�N{ER��me(Fee Simple Titlehold� 1_:Zi7 �1) �OZ� Phone#: Address: 5vS� /,4VJ ci2� City: YnY J404( State: -4=7L Tenant/Lessee Name: Phone#: Email: / CONTRACTOR:Company Name: L.�.� ��J�sa/T/OJ!%NC Phone#: �� Address: 29glo /V, W. �d City: lY'I�G � State: Zip: Qualifier Name: /VOr/.uGty! Phone#: State Certification or Registration#: Cwt✓ /.�/.� S`7 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Mrilh4w 49'r L6az a?_ -1w., Specify color of color 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$ l l 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 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." 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 low 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 willed an spection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of,fe a '/.�P�,20 by day of --';P� ,20 /;�,by PrL�f�who is personally known to /.��1� �Jr/ who is personally known to me or who has produced FDL— 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: Sign Sign: Pri Print: Notary Public State of Florida �rvi Notary Public Sta Se Q° Joanna M Feliciano Seal: 4y, Joanna M Feliciano • My Commission FF 082763 xA Expj�s OtI12120tmission �082753 Rod' Expires 01/12/2016 ov APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 001188 RIM Miami-Dade County, State of Florida =THIS IS NOT A BILL - UO NOT.PAY 6576475 LBT \1 J BUSINESS WdiBe E&OCA*TI<ON RECEIPT NO. rI LAO CONSTRUC'T`ION INC RENEWAL SEPnMRIER 30, 2016 2810 NW 70ME 6"7724 Must be' in ayedatpieceo€business MW FL 3,31,27 Pursuant to County Cade Chapter 8A—Art.9&TO OWNER SEC.TV,.QV OF BUSINESS RECEIVED L A 0 COidMUC71ON INC 796 GENERAL BUILDING CONTRACTOR BY TAX COLLECTOR PPAYMENTECEIVE Worker(s) 1 +rGC159f3 57 $45.00 06/25/2015 CRE©ITCARD-15--042299 This toot Business Terse Receipt Busineos.Ta).The Receipt is not a license, ponnit.nr a certification of the holdWs alificatio"'o 40400st.Holdermast compty with any governmental or nengnvemmelttal regulatory laweAkdrequiremems whI4a0 Cyto the business. The RECEIPT NO.above must be displayed on all commercial vehicles-Mia ni-!lade Code Sft la-276. Fa mote Infomtaa6an,visit www.miamidsde.gayitaxr:olloctm i i 12-c,- lZ lC� } i ;