RC-14-757 (3) Miami Shores Village - QED
Building Department APR 15 2014
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90050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY,
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20
BUILDING Permit No.
PERMIT APPLICATION Master Permit No. l --�•
Permit Type: BUILDING ROOFING
JOB ADDRESS: off?A�az
City: Miami Shores Miami Dade Zip: 3313f-'
Folio/Parcel#: to Is the Building Historically Designated:Yes' Flood Zone:
OWNER:Name(Fee Simple Titleholder): lam" i J.? Phone#: &;5Fz.--Q4M
Address: /Y ollalS ,- G
City: State:_ % Zip: 33/ 0
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name:oe//alp' Phone#: 3 0-5--K?7'Z6 S710
Address: 202-od A)U.) Zd. 17✓G, �t✓l�e (1
City: 5 -�— /AState: /f�/e!/>•�7 Zip: _ 3 3/66
9
Qualifier Name: 0 b ef_ly 6 D Phone#:
State Certification or Registration#: C C C 1549 96. j ,Certificate of Competency#:
Contact Phone#: 307 -6 7-2 t;_9 Email Address:.660 gE ZI 6&6& , q
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ 1� .�Df o °° Square/Linear Footage of Work:�/, .300
Type of Work: ❑Addition //�--❑Alteration ONew *epair/Replace ODemolition
Description of Work: rTe /fl1�Cr� c�f N V.)zf'� Cl�lh� � (�����aajs?
e s 1,4 o �w i) ✓Dr's/.
Color thru tile:
��x�exx��*xxax�e��x�xxxxx�x��a�x�xmxxx�Feesxxxxx�xmmxxx�xx�xx�xx�sxxx°�xxxx����ece�x����
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$ `� °
i
Lding.@Smpany'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: YOUI 'AILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT^c- YOUR PAYING TWICE FOR
f 19 Alk
IMPROVEMENTS TO YOUR PROP /j 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.
Signature Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged befow me this
day of, 2014�--by r� of �/` ,20 ,by O59--
day ,
who is personally known to me or who has produced who is personally 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:
FERNANDEZ J FERNANDEZ
is
Sign: �!" a' D V l AftSign: MY C ION#EE054428
.:*t MY ES January 11,2015
PrintJanuary 11,2015 pmt. QGm
My Com F1or1d8N0t8ryserv'.com
My Commission Expires:
APPROVED BY g Plans Examiner Zoning
Structural Review Clerk
(Revised 3/1=012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)