EL-15-1956 Miami Shores Village
Building Department JAN 14 2016
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(30S)762-4949
FBC 201D
BUILDING Master Permit No. ?'C 15—
PERMIT APPLICATION Sub Permit No. EL I s- Ig,56
BUILDING r--j ELECTRIC F-1 ROOFING REVISION EXTENSION [:]RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [;J/CHANGE OF ❑CANCELLATION ❑ SHOP
Q_ CONTRACTOR DRAWINGS
JOB ADDRESS: erZzD
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
( p ) ^�
OWNER:Name Fee Simple Titleholder): I G � � Phone#: 3d� �'"� � � Z
Address: e 2ZU /Q Z"�
City: 1"t1 4- S State: Z... Zip: 33 3 g
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: m e4 p L�t v�nCA1 �^^LQ Phone#: �S 3) O S'
Address: t i S Z W 12-B CT
City: ``1G��^^� State: Z. Zip: �3
Qualifier Name:
Phone#: 19 )<:)05
State Certification or Registration#: -PC 13 0 O=1 O-1 Certificate of Competency#: 08 zooy o l'o
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ t'JOD Square/Linearr Footage of Work:
Type of Work: El Addition [:1 Alteration,
1 New U Retpair/Replace ❑ Demolition
Description of Work:
Specify color-o color thru dieg
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
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 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 inspe ion which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will n t b approved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instru nt was acknowledged before me this The foregoing instrument was acknowledged before me this
Ayday of 20 by day of 9 20 by
/111OS1a l®�4t�SSA.- ona y mown to personally known to
me or who has produced as me o�wh asproduced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
rY RES
.•"
Print: -r �' MP - Print:F Y mm. xp s Oct 11,2015 = My C Expire Oct 11,2015
Seal: %' e:; C mmissio #EE 106714 Seal: �;E Co fission EE 106714
'•� Bonded Through National Notary Assn. ,
� � �''•� Bondi Through NOW Nott Assn.
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APPROVED BY r Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Miami shores Village
K na mn�
NN Building Department
g�A 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CHANGE OF CONTRACTOR /ARCHITECT
Permit N.
Owner's Name(Fee Simple Title Holder): Phone#: 30 G-"4(01 9-213
Owner's Address: 1 ZZU A)C V na_
City: tA\e—, v y State Zip C ode. --V37 LIQ,
r
Job Address (Of where work is being done): ZZ 21
City: Miami Shores State:—Florida Zip Code: 3,313
Contractor's Company Name: D �L�@L-�w►Ct�,� `�Y�v+ Phone
Address: -70 S:2-
Ci ,0\ L
�^^� State: Zip Code: �3114
Qualifier's Name: IA SVGS O A-, Lic. Number: :F;.L 1300 -
Architect/Engineer of Record Name: Phone#:
Address:
City: State.• I Zip Code.
Describe Work
1 hereby certify that the work has been abandoned and/or the contractor/architect
is unable or unwilling to complete the contract. 1 hold the Building Official and the
iami Shores harmless of all legal 'evolvement.
Signature Signature YZe-�
Owner or Agent Co erector or Architea
The foregoing i strument was aknowledged before me The foregoing instrument was aknowledged before me
this qday o 20 4(abylj& kA this day 201bby_-]:
Who is person kno o me or who has produced who is personally w�toor who has produced`
as indentification. as indentification.
Notary P bi Nota
Sign: ES Sign: blic-State of Florida
Seal My Comm.Expires Oct 11,2015 y C Expires Oct 11,2U t
Commission#EE 106714SeaI' 's'"�, � Commission EE 106714
Bonded Through National Notary Assn. � #I s� ' Boaded Throagh N 81 Notary ssn
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