RC-15-3147 (2) Miami Shores Village �, .1 «�13
Building Department JAN 7 20%
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 G/ /fig
FBC 20� c
PA
BUILDING Master Permit No. •12—/✓r-'•3fy7
PERMIT APPLICATION Sub Permit No. Rcy 22
gi'Ll Ej ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
❑PLUMBING F-� MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF CANCELLATION SHOP
�rCONTRACTOR DRAWINGS
JOB ADDRESS: -z/ Alk� /Osyd
City: Miami Shores ) County: Miami Dade ZID:
Folio/Parcel#: >'l.�I"RZ-VIN Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE�: Q�p FFE:
OWNER:Name(Fee Simple Titleholder : y hT/� �� (I[f71AM Phone#• �+-
Address /4►* '
City: ,lam State: jZip: 411E+"
Tenant/Lessee Name: I� Phone#:
Email: •V �+ leOD
LL A
CONTRACTOR:Company Name: iW JAMM4 Phone#:
Address:fw/ff
City: State: 1-- Zip:
Qualifier Name: % '' Phone#: ?��"�►�! •��/
State Certification or Registration#: I—Va.7•" ! Certificate of Competency#:
DESIGNER:Architect/Engineer: i � l9 Phone#:
ICi ,/
Address.,&* City: 7lL�s;fl� !'lamtate• *'L- Zip:
Value of Work for this Permit:$ itri alvipw Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New eepair/Replace ❑' Demoolittii'on
Description of Work:
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ r Radon Fee$ DBPR$ Notary$ "
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ ��� • t��
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City 1 "I'l :''.• « • , �r State Zip
I
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,by Oope 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`POOPERO .`14F'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 OceedinkSZs00, the applicant must
promise in good faith that a copy of the notice of commencement and'construction lien law brochure will-4e delivQr�e¢16..the person
1.whose property is subject to attachment: Also,a certified copy of the recorded notice of commencement mush ie pd3'ted ht'the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of ch posted notice, the
inspection will not be approved and a reinspection fee will be charged.
411
4
Signature signature
'OWNER or AGE , CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of �Cp.NUAe::�J ,20 0 2 .by day of ,20 by
Sciip'N who is personally known to who is personally known to
me or who Itas produced-f\ Li U-DJ&as me or who has produced . � as
identification and who did take an'oath. identification and who did take an oath.
NOTARY PUB NOTARY PUBLIC:
Sign: Sign:
Print: Print: 'Q0_ "nomLF
Seal: P Pobtic State of Florida Seal: _� o a?co
�gpRY � Notary '•. _
Sindia Alvarea
ca My Commission FF 138750 0
"dF Expires 09/0312018
...•
APPROVED BY 1 V Plans Examiner Zoning
Ds,61/ Structural Review Clerk
(Revised02/24/2014)