RC-15-821 (4) Miami Shores VillageT ���� �
• Building Department APR 28 2016
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 '-3y_
Tel:(305)795-2204 Fax:(305)756-8972 --
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 N
BUILDING Master Permit No. jZC J S — &2vf
PERMIT APPLICATION Sub Permit No. V.6y 16
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION [-]RENEWAL
❑PLUMBING ® MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
/� CONTRACTOR DRAWINGS
JOB ADDRESS: I D �O / 4
City: Miami Shores County: Miami Dade Zio:
Folio/Parcel#: T/- '0_-5-V® Is the Building Historically Designated:Yes NO
Occupancy Type: Load: //Construction Type: // Flood Zone: BFE: ,/ FFE:
OWNER:Name(Fee Simple Titleholder): .1.�P TSS •��l/� I-L 12 Phone#: �7 �7� �`1"
Address: 'z 7L�,L-� � /�-�'.S a [%����
City: F/ - State: Zip:
Tenant/Lessee/Name: Phone#:
Email: .6 feIla/A/ rl'L j6-2
CONTRACTOR:Company Name: 401 ���� Phone#: _":V757 a&g �ZS& 7
Address: 4(047-1,q F,06) xFfle.
City: &/'a/'W% State: �`� Zip:
Qualifier Name: zwene AC7U7-l-le Phone#: .?d 2'e®7— 200
State Certification or Registration#: 4!ZY(L 1091'7 ?-2-6 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ DemolitaDescription of Work: L --� -1 ?- < lea . 09
_
g'6 CL, ,- �2vt s 1
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Z)p
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 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.
Signature Signature X
NER or AGENT CTOR
The foregoing instrument was acknowledged before me this The fore oIng instrument was acknowledged before me this
day of 020 16 ,by 21 day of . Yj
7 / 20 /0 ,by
� r
�t/Y✓� ,who i^ s personally known to ` U1in�iffo s personally known to
me or who has produced 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:
Sign: - - Sign:
Print: 4EN PIEReE Print:
Seal ,clic-State of Florida Seal: _t aYp�a•
hires Oct 30,2016 GI �MY MARTINEZ
n # EE 847983 MY COMMISSION#FF153840
EXPIRES August 24,2018
s+� xsaaaxe saxxacar war s *wx�* w+ +r* a s* as*xxa+�**aexesx* +r+ r* OWN***
APPROVED BY Z PIs Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)