EL-14-1973 Miami Shores Village cE �
. APR 1:7 2015
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 $Y•
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 t®
BUILDING Master Permit No.Pf
PERMIT APPLICATION Sub Permit No.�
❑BUILDING VELECTRIC ❑ ROOFING 16 REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF E]CANCELLATION SHOP
,( CONTRACTOR DRAWINGS
JOB ADDRESS: '1 � s NF- (J` E�
City Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: ` r Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): JaA f11�.. ��W � Phone#: &9'6 3L—5;55S
�
Address: 9L t5_0
City: WGMl` Sif l°S State: Zip: -?3t3 8
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: CAW McTKM se,Ry 1 C€ Phone#: 365 V70-0'q
S
Address: 00 5l,l" GAA E�LV t r
City: M 1 AA 1 tt � A pS�tate• �� Zip: II` �i y P
Qualifier Name: ��r.�' 1A GA MA V®6 Z Phone#: W5 DO-63q.5
State Certification or Registration#: &C A 300 5744 LA 2 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: �•- City: State: Zip:
.J
Value of Work for this Permit:$ o0`�
Square/linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration [ New ❑ Repair/Replace ❑ Demolition
Descriptio
LC kAld
ENO U
Specify o 0 o r +►,,
Submittal Fee$ Permit Fee$ / d CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ ��
TOTAL FEE NOW DUE$�� •013
(Revised02/24/2014)
�_f
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 estimpted 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 inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature V P Signature
NER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument Was acknowledged before me this
day of®►FJIr�'� ,20�by wk day of &+& 20 5 .by
who is personally known to -VkA� ho i enarsoy now o
me or who has produced 7 tO �s 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: NANCY NERNANM
o Notary Public-She of FWM
Print: Print: a Comm.Expim Feb 82818
,s
na Coaiaiksfn 0 EE$$19009Seal °u®` Notary Pubic State of FloSeal' ;°a`� Bpfftd TlirpugA N2ti0 W MptBry Assn,
Joanna M Feliciano
y, My Commission FF 082753
"�OF�ao� Ey1P1res 0 1 11 212 01 8
�y anis'
APPROVED BY ^ �/� /�'f1'P'lL Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)