FW-14-1290 f
Miami Shores Village -CEIVED
Building Department JUN 18 2014
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 $�
�f Tel: 305 795.2204 Fax: 305 756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
r
B Permit No.
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type:BUILDING
OWNER:Name(Fee Simple Titleholder): d,0S Phone#:(;A) `7 ZC,:)o- 1!D j
Address: 1 D
`1
City: I�iar1 t IntSYPS State: R 25 5 15 0
Tenant IAmee Name• Phone#•
Email:
JOB ADDRESS:�I D q- t4 1) 9-15P.
VP
City: Miami Shores County: Miami Dade Zip:
Folio/Parml#: 1 '0 0),C� 1)0!&
Is the Building Historically Designated:Yes NO Flood Zone:
CONTRACTOR:Company—Name: C'� I �/ Phone#: �-� -
Address: / ,
City: ____.Xip:2_2dk 62.
Qualifier Name: �.. Phon • q5X
State Cerfific ation or Registration#: J l . Certifi of Competency#:. cf zo
Contact Phone#: Email Address:
DESIGNER:Architect/Engineer. Phone#:
Value of Work for this Permit:$ ��0 6 Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace LJ30molition
Description of Work: Lf 1 °
COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by:
r�,�,�,�,�,�,�ta*�,x,�,�,��,��r�,x�,�a*ar,�a�*o,r,�,ria,�,�,�,�F�,��,►,r,�,�,��,x,�,�sa�,t,�,u,x**art,t,�,rt�ra�r,t�r�rta*,r,t,t,a*,tea*
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE 5
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 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 certified copy of the recorded notice of comme meat must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued I t absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged
Signature Signature
or Agent .,,. Contractor
The foregoing instrument was acknowledged before in oing instrument was knowledged before me this
day of by 20, by U1 r-ip� ,
o is personally known to or who has produced who i Ily known to me who has produced
As identification and who did take an oath. -as identification and who did take an oath.
NOTAR UBLIQ NO LIC:
Sign ANA M.TORRES Sign:
.r _ ary Public-State of Florida
Pant• 2015 Print: a• Commission#EE 110471 ;_� v °�,� Notary Public-State of Florida
My Commission Expires: • ,; ° My Commission Expires•
Banded Through National Notary Assn. � ?.;�;.: My Comm.Expires Jul 7,2015
Commission#EE 110471
Bonded Through National Notary Assn.
unu•`
011
APPROVED BY 7 i Plans Examiner
Zoning
Structural Review Clerk
(Revised 07/10/07XRevised 06/10/2009)OWised 3/15/09xreW4/10)