RC-15-1784 (5) �1 Miami Shores Villager
Building Department artment JUN 09 2016
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 ��
INSPECTION LINE PHONE NUMBER:(30S)762-4949
FBC 20
.17
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit Noah lb- /_,;
TeUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 51—
City: Miami Shores County: Miami Dade Zip: �j 31 736
Folio/Parcel#: 1) - 3 Z05 — 0'�4 — 0 /q 0 Is the Building Historically Designated:Yes NO_ X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): My COPSI-IRO(d W F D!/ Phone#:
Address: 20/ .5 3/5c6 N 0E N-VP A W3 Z j
City: M4 O &Lj State: -P-401;1-/DO Zip: A3 131
Tenant/Lessee Name: !4A Phone#:
Email:
CONTRACTOR:Company Name: A'/CNQ CVP'-VM MW Phone#:q!�"y �t 4
Address: ,561 w 50 7,�PFR ci,2
City: pLmj5moze pfNE5 State: PI-0P-4D0 Zip: '"330?,
Qualifier Name: fOR AC40 M4`Z02 Phone#: 4151 r 9,6 tS -_s
State Certification or Registration#: _c cnc 15 17 S 49 y Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work: `f?.0
Type of Work: ❑ Addition ❑ Alteration [9�New ❑ Repair/Replace ❑ Demolition
Description of Work: N E W tP9- '2 00L LA D D-)IL)G ®Zrt—aZ 0 X 5T-,m G, Mt-_W17,-;E s
Specify color of color thru tile:
Submittal Fee$ 0 Permit Fee$ 1 �1 ° CCF$ -3 -00 CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ - c�"t Notary$
Technology Fee$ Training/Education Fee$ �® Double Fee$
Structural Reviews$ 12-0 'Q Bond$
TOTAL FEE NOW DUE$ '
(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 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 comment me t must a posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issu d. In the bs ce o uch posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signa
WNER or AGENT CO TRA OR
The foregoi g instrument was acknowledged before me this Th foregoing instr nt was acknowledged before me this
V day of_C�4A A- ,20 ( (0 .by A- ,20 f �O , by
who is personally known to .c:c_� r`�h�— ' ,who is 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:
Pri .• Print:
MA COS LAA-RES
2—=
Sea - :•: GQMMIS310N#EE872882 Seal: EXPIRES February 07,2017
EXPIRES February 07,2017 F servme.=M
3960753 Fwnd&mdwyswvi==m
APPROVED BY `t Plans Examiner ` Zoning
Structural Review Clerk
(Revised02/24/2014)
�
l E�
_ Miami Shires Village
Adak, J N 0,9 2o%
APPROVED BY DTE
c lly
ZONING DEPTu t
*117
T
e�
0 CCh1PL CE WITH ALL FME
STATE ANL)CCI-)NiY ALL,-:S AND REGULATIONS
O O O o
FRONT ELEVATION
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.242" (6,71 mm)
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Material Stainless Steel Insert Available Colors
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Polyethylene .883"x.883"
Thickness: .036"
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