BPP-15-1590 (2) Miami Shores Village CIIna E
g Department DEt 1, 015
ARNIN[ nue,Miami Shores,Florida 33138
5-2204 Fax:(305)756-8972 BY:
�KEVISI (n17N PHONE NUMBER:(305)762-4949
FBC 201c�
BUILDING Master Permit No.19 p P-Ao -IS7- ts'Qa
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING 2EVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
1 /� CONTRACTOR DRAWINGS
�y
JOB ADDRESS: 1 *�iy E 16 4 J-t
City: Miami Shores Countv: Miami Dade zip: 3 513 IF
Folio/Parcel#: I"a a;3 a --03a— 0 b Q n Is the Building Historically Designated:Yes NO
Occupancy Type:RK416. Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple`titleholder):pT- gn,J 2 rne5 t M A r Phone#:
Address:_ 4 T 1 WF 104 -C*
City: M i
p:
A M 1 �'1�Y,i°S state L. zi 3 13
Tenant/Lessee Name: Phone#:
Email: ` / '/ l
CONTRACTOR:Company Name: V Q til VNVV- (111J 10 S Phone#:Q$Zl-7$'S- 446A
Address: 31 y s ttS Ltd 13 Dr-
City: �)i 4
i G(d AP[I d'1 State: VL Zip: y
Qualifier Name:A 66,e 4- V a r% -i l k,,:C"• Phone#: gS'Ll"tSS-Vya'� .
State Certification or Registration M dLis Q r ~ . Certificate of Competency#:
a t a `ii a� s s ;
DESIGNER:Architect/Eilgineer: d v� Phone#:44-q1 1-16 K S"
Address:x'110 0 N•pp Wt[line-JU. Su i 4e- h, City: l3 • State•PL Zip•SS0 3
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration /❑ New ❑ Repair/Replace ❑ Demolition
Description of Werk: , . ,.�,/.l t,��+�C /�f,�-zc - y.�.` �•4' -,a.
, pedfy calor of.colorthru tile:
Submittal Fee'$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ 3 Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ `� 6
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name(if applicable) , .Y
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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 dpplicant 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.
SignaturJinstru
Signature
OWNER or AGENT CONT CTOR
The forement was acknowledged before me this The(foregoing instrument wa acknowledged before me this
7 day of 20 ,by a day of 20 15 ,by
who is personally known to &W -PON who is personally known o
me or who has produced FL PX- G it as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Z'
Sign: C� ��/ Sign:
Print. F Print:
.►�� "� i�` CRYSTAL N JONES
,� RICARDOIRIARTE
Seal: i Seal: ' MY COMMISSION('1 {• MY COMMISSION#FF088738 +� j
' EXPIRES February 2.2018 ?�.. EXPIRES May 28,2018
�..» (4W)�e o�ss
(407)388-0153 FbrldaN�r3arvlcec�m Serviceoom
**************************** *** ********************************************************************** *
APPROVED BY f �� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
• • •• • • •
Miami Sikores Village
• . • :Building Department
• • 10050 M.E.2nd Avenue
Miami Shores, Florida 33138
bp? (S— t��d .. . . w w •. Tel:(305) 795.2204
. . . . . . . .
... . . . . .. Fax:
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