MC-14-760 Miami Shores Village =BY.
. : *
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20
BUILDING Permit No. lI(I&
PERMIT APPLICATION Master Permit Ivo. —
Permit Type:MECHANICAL
JOB ADDRESS: Wi MVI) 10 "t'4
City: Miami Shores County: ami Dade zip: 331
Folio/Parcel#: 11 Z 06G —®(D 1 -10
Is the Building Historically Designated:Yes NO Flood zone:
OWNER:Name(Fee Simple Titleholder): G V 1 UMk4 O AUH Arte!► Phone#:
Address: eq N W __1 )(O1r} 1',�'' T2E_e'T -
P
City: M i h"l `� ''\\UP.t✓S State: T—WX tIZ�11>1 zip: 153,5�
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: A ck L 5azy 1 G e-S -XM G Phone#: Ws of 4015 38
Address: ( 5 CIS 6V-) LN-0 Cr X T ICS 1 1 U
city: 1�4 i A.M l State: -f-,Lu CA C>A zip: 331$ '3
Qualifier Name: fLl.Ac tJ i7U LAIZ,l A Phone#: 305 al'�O 1 3�
State Certification or Registration#: CA r 181 (V Z 3Certificate�of Competency#:
Contact Phone#: XX3$
066( 15 Email Address: i7A kxr is i g9 6D `1(A hop •Co W'%
DESIGNER:Architect/Engineer: Phone#:
3 x241
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Square/Linear Fo�.���k�
Type of Work. DAddress OAlteration lew t]Repair/Replace ODemolition
e ►fr' a il/ ieJ �rh!i.0 �sirl %SZtvr acs
i.n e5
8,
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$
J
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 thv A4Vd installations as indicated. I certify that no work or installation has commenced
prior to the issuance of a permit and that all work wild to meet the standards of all laws regulating construction in this jurisdiction.
I understand that a separate permit must be secured fbr*,,EFPCIAL,WORK,for*, PLUMBING, SIGNS, WELLS, POOLS, FURNACES,
BOILERS,HEATERS,TANKS and AIR CONDITIONERS,ETC.-i.4
OWNER'S AFFIDAVIT: I certify that all the foregoing informatioQi4curate 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$2500, the applicant must promise in
good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is
subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which
occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a
reinspection feewill b char d
JA
Signature Signaturenb CII
Own ent Contractor
The foregoing instrumen was acknowledged before me this The foregoing instrument w acknowledged before me this
day of_ 20 ,by U ( -,'Wv day of 20 ,by
who is persoO&J=wn-to me or who has produced who is p$rsonally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: EZ
Print: FERNQ►NDEZ Print:
MYGUMM
My CommissiD-1*11' ,
EXPIRES January 11,2015 MY EXPRWES January 11,2015
(407)398 0153 FloridallotaryServioe.com oil"
407)398-0153 FloridaHlotaryService.com
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APPROVED BY � lens Examiner Zoning
Structural Review Clerk
Revised 3/12/2012XRevised 07/10WXRevised 06/10/2009XRevised 3/15/09)