RC-15-1694 (2) . Miami Shores Village
AY�- Building Department NOV ®3201' ;
10050 N.E.2nd Avenue,Miami Shores,Florida 33138XM ISI I
5-2204 Fax:(305)756-8972 '
&W RPHONE NUMBER:(305)762-4949 _
FBC 20
BVI M Master Permit No. e(- 1 _ ,G9 y
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING FrREVISION ❑EXTENSION ❑RENEWAL
[]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [] CHANGE OF ❑CANCELLATION r-1 SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: ID N rCr 9' !!54"W-y
City: Miami Shores County: 1 ` Miami Dade Zip: 33
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):_ Do ria d 14a!1d e r Phone#:
Address: 31 V H16F �'1'q 54• t�
City: dF % 5'1-0 r e S State: j & zip: 33/30
Tenant/Lessee Name: Phone#:
Email: ��^^ /
CONTRACTOR:Company Name: Ya b I-h k r!e✓ �F Fx erto r- Phone#: 7e)6 9 57IQ34-0
Address: . -1/0"D e �J�✓G�
City: State: EL Zip: 33126
Qualifier Name: -FG 6i0 C/SJe,-n ova Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Unear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: UfS���� - sjrve�V--d (he J4
K!k ti QA-h'rodtiy^,
Specify color of color thru We:
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$ 1-1® • 00
(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. 1 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$25W, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brgachure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice ement must be posted at the job site
for the f/rst inspection whic curs seven (7) days after the building permit Is.' ence of such posted notice, the
Inspection will no d a reinspection fee will be charged. S,t .,�OF
t,1p'iARY��DA 18 -
ArAIMW
S'f
Sign Signature
OWNER or AGENT CONTRACTOR
The foregoing Instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
-?Q day of 19r4OL&K .20 6 ,by 3 day of AOyem6er ,20 ;9 ,by
VQN!A� NAy0�'.# .who Is,_personally known to P4910 USrf)7N/ND who is personally known to
me or who has produced 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: AV
Print: d Print: 0 i l
Seal:
Seal:
,L-
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APPROVED BY �� /® � Plans Examiner Zoning
illlw Structural Review Clerk
(Revised02/24/2014)