CC-14-927 Miami Shores VillagecErv�ED
Building Department MAY 29 2014
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY:
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit No. 90 7'
PERMIT APPLICATION Sub Permit No. f/o/
BUILDING rMLECTRIC ROOFING REVISION EXTENSION RENEWAL
PLUMBING MECHANICAL [:]PUBLICWORKS [:] CHANGE CANCELLATION 0 SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: / �C�� �f Z,
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: II,^, Flood Zone; BFE: �FFFE:
OWNER:Name(Fee Simple Titleholder): Rr�M
t l lo� ��r Phone#:
n �• 4��`��
Address: 240
City: 141.1 State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: QLALPhone#:1
Address: s AN
City: &r
Zip:
Qualifier Name: Phone#: NO"qr"
State Certification or Registration#: EZ 00 2 7 C Certificate of Competency#: E 000 C 3
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ /-S Square/Linear Footage of Work:
Type of Work: ❑Addition /❑ Alteration ❑New Repair/Replace 1:1 Demolition
Description of Work: L�� ' ���lc."4
Spec*color of color thru tile:
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$
Bonding Company's Name(if applicable)
Bonding Company'$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 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.
SignatureSignatur
Owner or Agent _4WAR` Contractor
The foregoing instrument was acknowledged before me this The g instrument was acknowledged before me Jr
this da of rt 20 by 4�1,-Im day of 20 by -�
wh is pe sonally known t me or who has produced who is w o me or who&produced
identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBL
Sign: Sign: LA-,v
�D
Print: �I �r Print
My Commission Expires: OFIrrUM 1 My Commisp ;.PA A165R Tf10S0'y��
Al COMI N10N l FF084212 :�~' G@ ms's_CCMM!S!CY EE073678
111
'•• i rhr * 1un4�Za17 s�� �=EXPIRES:MAR.14,2015
• •.,,SOF AARONNOTAR1:art
s*,&ONs
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)(Rev1sed 5/2/2012)(Revised 3/12/2012))(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)