BPP-14-2660 i
Miami Shores Village DEC 0 5 2014
Building Department BY:
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
n Tel:(305)795.2204 Fax:(305)756.8972
`a INSPECTION'S PHONE NUMBER:(3055)762.4949
FBC 20 10
BUILDING Permit No.BEP I�1-' 9MO
PERMIT APPLICATION Master Permit No.
Permit Type: BUILDING ROOFING
JOB ADDRESS• q'SG ,d,ko km 'SA
City: Miami Shores County: Miami Dade Zip:
FoliolParcel#: I( 71 20 Q c^�1'3 S 0
Is the Building Historically Designated:Yes NO �_ Flood Zone:
OWNER:Name(Fee Simple Titleholder):V. - 'te l- ,—Church.4 ftA _AtuThone#:
Address: tri.56 W Q 1C XJ AYXS�
City:Rtu.int Seri State: rlL Zip:
Tenant&essee Name: Phone#:
Email:
CONTRACTOR:Company Name: Phone#:q � � -712-Lb
Address: °
City: RCt.Q;j:hA-err '' State: Zip: 3,�6-2
Qualifier Name: M LGFtt�Q 1 a ci c Phone#: -
State Certification or Registration#: L GL151`4 ®"-'E.9- Certificate of Competency#:
Contact Phone#: 61!>l Email Address:
DESIGNER:Architect/Engmeer: Phone#:
Value of Work for this Permit:$ SgaareaAnear Footage of Work: "1
Type of Work: OAddition []Alteration )INew ORepair/Replace []Demolition
Descrlption of Work: l o d_ eZ:&�%cA %,_Q%we %(NtA �c�\
Color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Trabdug/Educadon Fee$ Tedmology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
t •t j.
• Ronditq Company's ame(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 ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 ce copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) day wilding permit is issued In the absence of such posted notice, the
inspection will not be roved and a reinspectiok fe
Signature
Owner o ant Contractor
The foregoing instrument was acknowledged before me this-2v- The foregoing instrument was acknowledged before me this2-s�l
amu►
y of
da ,20 M.by 7S s. day of AI IJ.Jo&6C ,261w,,,by M, , eiae-<- ,
who is personally known to me or who has produced—!--- . who is personally known to me or who has produced
L,KC!M1M As identification and who did take an oath. J� I�r_aria as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign: r� yl�y
Print: Print: ee,C
E C HAMBRICK KYLE C HAMBRICK
My Commission Ex pir s "' ,, KYL My Commission
.•, •r MY COMMISSION#EE867056 �'= MY COMMISSION#EE8670W
r EXPIRES January 22,2017 EXPIRES January 22,2017
APPROVED BY Plans Examiner zoning
Structural Review Clerk
(Revised 3/12012)(Revised 07/10/07)(Revised 06(10/2009)(Revised 3/15/09)