CC-13-1755 f
t Ui
o Miami Shores Village AUG 0 5 2ui3 1'
Building Department ��:-amaoaoeoeoovooe000e
d\
!0050 N.E.W Avenue.Miami
Shone Flaanda 33138
Tel:
(305)795.2M Fax:(305)756.8972
INSPECTION'S PHONE NUM B$g:(305)762A949
BUILDING FBC 209)
PERMIT APPLICATION Permit No. l�-'
Master Permit No.
Permit Type: BUILDING ROOFING
/d'� R ADDRESS: t 3 Z. 9 (%r&- l 0 '5 L T
FolicJPaml#: ! 1 3 2 _ OZ 7 -
o06c>
Is the BW1dW9 Sistori"y Designated:Yes NO X ]flood Zone:
OWNER:Name(Fee Simple Titleholder): -l-1 A R A-nr,cF j,L e ,►.� . 0.0�t •`1
Address• I 0 4-a N- I t�t ST
City: iS e A y t P er a � state• �L Zip; 3-131 6
TenantUssee Name:
Email:
CONTRACTOR:Company Nam: A h C IV' GL11 G
L� T12 , c p „ ; �8 6 4 02 46 s
Address: 1? 151 vLo 12 `TE 2
{sty: r A
Qaaliter Name: ��R W" 2 0 A N nr
! ! '0 ; A�.IM.sII._U6 "'gym y
�n
State Cadficadon or Registration#: C 6- G (� 3 3-D 4 Certificate of Competes►#•
Contad Phone#: inag Ate•
DWGNIRs AwVWcVEngineer; ` oma#•
Vake of Work for this Permit:$ Do 0 ftp,F
Type of works OAddidon OAheaadon O0 °f work:
t]l�Tew �pairiReplaoe oDemoMion
Din of work: R Fro i l 0 0 A N1 R &-e!) c ® tJ c rZ zt L �-
RCCy ArM h RE �LP�e PAib or—
Color dwa file
Submittal Fee$ Permit Fee$ CCF$
Fee$ Ramon Fee$ MCC$
DBPR$ $
Nof'y$ TraWn=JEducatton Fee$ Tedwolopy Fee$
Double Fee$ S&Udm ai R $
TOTAL FEE NOW DUE$�„__ gr C6
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 �P
Application is hereby made to obtain a pwait 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.....
OwNFR'S AFFIDAVIT: I certify that all the foregoing infomittion is accurate and that aA 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 cenV!ed copy of the recorded notice of commencement must be
for the fust inspection which occurs seven (7) days after the buifiis permit is issued. In � os at the job he
�P e of such posted notice, the
inspection will not be approved and a reinspection fee will be c
Signature A " Si
Owner or Agent G
The foregoing instrument was acka T The foe*gt w�,ackno ged bef • +-�
day of 20 15.by 6 tlOkrt"
:C v day of 20�J by
wbo is y known has produce wh is o tt3l known me or who has�pmduced
'3' Bcation and who did take an oath. Paul kation and who aid take an oadn.
NOTAY LIC: qbTAR PUBLIC: • •
Sign: B1LL05 Sigma C LOS
Notary u is- a
e t Florida
P&t. in Exones Sep 23.2015 Print: - �> My�umm Expires Sep
Commission#EE 128810 810
Mycommission -" . •°� r Assn.
Bonded Through National Notary Assn. My CODImiBsi ►� Bonded Through National NO
f;
. .
7APPROVED BY uJ Plans Encaminea'. Zoning
Shvchual Review
Clerk
Otevtsied3n2/2012)0tevised07nQVXRevbeao6num Xitirvised3nslo9)