RC-15-1884 (4) Miami Shores Village =BY:. i
Buildin De artment g p10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
,FBC 201`
BUILDING Master Permit No.�'�
PERMIT APPLICATION Sub Permit No. PLV l
❑BUILDING ❑ ELECTRIC ❑ ROOFING ET-R'EVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING P<ECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
�
�(l / ,� CONTRACTOR DRAWINGS
JOB ADDRESS: 8q/ e, /0�' �5�`
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone — BFE: FFE:
OWNER:Name(Fee Simple Title older): t Phone#:
Address: r—, • 22 v
City: ' —State: 15:'
Tenant/L ee Name: Phone#:
Email:
CONTRACTOR:Company Name: Z, Phone#: 'Z
Address: Z 2 �r
City: M 412V 1 State:
Qualifier ame: Phone#:
State Certification or Registration#:��_ '� 0,-,F02-0 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 ❑ AlterationJ ❑ New ❑ Repair/Replace El Demolition
Description of Wofk:" G9'le.ea dV b T O1v4
✓_V f
Specify color of col hru tile: �o
Submittal Fee$ Permit Fee$ 1 ,50 VtOV CCF$ ® CO/CC$
Scanning Fee$ QZ� Radon Fee$ DBPRR$�1;;'L" --S Notary$
Technology Fee$ • i-°AJ Training/Education Fee$ t) " dy Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
Bonding Cowffr,�ny';,IN, �p(if applicable)
!I5._.
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 volu exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law b chure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commecement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. inti
nt a absence of such posted notice, the
inspection will not be approved and a reinspecti be charged.
Signature Signature
ENT NTRACTOR
The foregoing instru nt was acknowledged before//me this The for mg instrume t was acknowledged before me this
r 9 day of Ct--( .20 by day of 20 �J� >,by
who is personalto d ��. ,who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign: 146
COS LUNARES
=•• 'K ON 0 REe72882
Print Print EXPIRE$Feb vwy 07'2017
MY COMMISSION
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Seal, �' 63 oom Seal:
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APPROVED BY i 1 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)