EL-14-2662 Miami Shores Village CFTI
DEC 0 b 2014
Building Department BY:
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
�
FBC 20 10
BUILDING Master Permit No.%5pp A/- 22,6,/
PERMIT APPLICATION Sub Permit No.cl &I-" 266
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 1 t _*5_,)_0( CAI d7?S(,- Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): LR j. '5 oSe Of Sea —Ch v,ru, ges%ji tec#ftne#:
Address: �%,n.tyu lky`e5 G
City: lacy 10- S7 `�' State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Phone#: QVC
Address: Y e
City:.rz'c l'nc.I= C('eA(C_ State: Zip: 5� 0-7
Qualifier Name: S% Phone#: 9�3_l M S7
State Certification or Registration M —7 Certificate of Competency M
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
a uk#or this Permit:$SCAy 0 Square/Linear Footage of Work:
Type of Work: a Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition
Description of Work:Q.i1�d CZAA
Specify color of color thru tile:
Submittal Fee$ 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
Ibity 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,
�,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 ' e copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7} wilding permit is issued In the absence of such posted notice, the
inspection will not be approved and a reinspection
Signature Sigi 'r
Owner or Contractor
YrI
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 t-1k by ,.uruc� Z- Cts day of
who is personally known to me or who has produced who is personally known to me or who has produced
(-4..f� As identification and who did take an oath. TA, trkcP rft as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign9('44Z, Sign:le
Print: a 'eZ Print: GVCrt &e_2-,2/o,a w.
KYLE C HAMBMCK
My Commission Expires _ My Co iso xp
•'= MY COMMISSION#EEWFM ue�CYLE C HAMOMCK
EXPIRES Jranuaty 22,2017 •`= MY COMMISSION#EESSM
EXPIRES Jammy 22,2017
as .a*s x sia ese ee a xx* mxaa*axe a* I w +�a ****x ****
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12=12)(Revised 07/10/070.evised 06/10n.009)(Revised 3/15/09)