MC-16-660 Miami Shores Villag6
--�C-� Building Department 2
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 1AAY II'
Tel:(305)795-2204 Fax:(305)756-8972 -
INSPECTION UNE PHONE NUMBER:(305)762-4949
B ?QL
BUILDING Master Permit No. 01 1!2-1
PERMIT APPLICATION Sub Permit No. -6 ! 2.cI�S
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION E]RENEWAL
❑PLUMBING IMMECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 0
City: Miami Shores County: Miami Dade Zip: A31.0
Folio/Parcel#: !/-a 2---4,- 10 Is the Building Historically Designated:Yes NO/<
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): ")70-vA . �i9/'�r�� 165L't` 1-4e— Phone#: f PX 7.0
Address: ,Xry A/,iS7-,?/ Jr
City: State: r` G zip:4/m
Tenant/Lessee Name: AIIA . Phone#:
Email:
CONTRACTOR:Company Name: //Z �aa//�� `�� Phone#W 3 �
Address: :7�O 4;to W 6'7 SO 4r t lc-
City:
City: K aL,.� State: ,7`���^c. Zip:
Qualifier Name: .f�s e '� 6 c/C�- C Phone#.4Z,�Z3( 3 `�tf
State Certification or Registration#:C.4e /Y/-S 7 Z/ Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:23 jlo87 b
Address: Z7 City: State: Zip:
Value of Work for this Permit:$ Square/Unear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace,--� ❑ Demolition
Description of Work:_ is t s r ® � P1�IV
Specify colors color thry tile:
Submittal Fee$ Permit Fee$ CCF
Scanning Fee$ C9` . Ml Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ OD
(Revised02/24/2014)
Bonding company's Name(if-applicable) Ald
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State Zip
4 e '
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$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.
0
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of a _,20 by day of_ c� 20. 1 .by
�� o� r who is personally known to M:5 � �� ,who is personally known to
me or who has produced as me or who has produced E-- ��vl as
Identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
U11119d��� ,
Sign: Sign: •,••••••
Print: N GQ-1 I C Cc lm"" c tg-0-0 Print: _
Seal: < ": AAP3E!tCALL Seal: �"• � ti��t�'
MY COir.-WM#FF M7435 �u�•• o • ��
EXPIRES:Noordor 18,2D19 y�� Sia`::•
TAPPROVED
BY P ns Examiner Zoning
64, U-
Structural Review Clerk
(Revised02/24/2014)