EL-14-2641 (2) i
Miami Shores Village OCT X8 2015
Building Department L'==
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION UNE PHONE NUMBER:(305)762-4949
F BC 20 l�(
BUILDING (waster Permit No"41-2—o:--- ,— 2,G �C0
PERMIT APPLICATION Sub Permit No.1- '-A °T"
Zq
BUILDING ELECTRIC [] ROOFING /" REVISION ❑EXTENSION []RENEWAL
[ ,PLUMBING ❑ MECHANICAL [PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION 4 -VHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:IQ? N(D?_I 6T
M; Miami Shores County Miami Dade Zio'
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): J)C�F3F TT L LC Phone#_
Address:
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR Company Name:_�� �y Phone#:
Address' /,, ` l
City:, .��'L 1 � State: 1--- Zip: - l
Qualifier Name: PA Phone#:
State Certification or Registration#: e-' l3®®�! Certificate of Competency#:
DESIGNER Architect/Engineer: Phone#:
Address--
qty: State Zip:
Value of Work for this Permit:S Square/Unear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Ca-1-pE''1OM L-- -TE
specify color of color thm tile:
Submittal Fee$ Permit Fee CCF S CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ �� •f�l
(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
qty 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$250, 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 flrst 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 Signaturecov(
R or A CCWRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
_ day of 6 CZWK— ,20 IS .by � day of Oct 20 1-5— ,by
/4N111tk U�ty4. ,who is personally known to who is personally known
me or who has produced " 'w as me or who has produced as
Identification and who did take an oath. identification and who did take an oath.
NOTARY PUB NOTARY PUBLIC:
Sign: Sig
Print, 4--L Print. .••'111#1
blic of Florida `-��• Cl: HIAXIIVIO ROD
Seal: Seal: _• e Nota
REpu Fuentes - ►yPublic-StateIGUEZ
misabn EE 841144 �Y Comm, of Florida
10/09/2018 '%°�S�3P�`° Commission 'as Jul 5,2016
#EE 214350
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APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)