RC-15-1884 (5) Miami Shares Village
Building Department 910Z 0.Z OBJ
Q
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fwc(305)756-8972
INSPECTION LINE PHONE NUMBER:(30S)762-4949
FBC 2014
BUILDING Master Permit No. 9cf: '5 1 �
PERMIT APPLICATION Sub Permit No.F-C-,V 16—(+q 5
BUILDING ❑ ELECTRIC ❑ ROOFING 2/REVISION ❑ EXTENSION ❑RENEWAL
(]PLUMBING ❑MECHANICAL MPLIBLICWORKS ❑ CHANGE OF CANCELLATION M SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS* )
1�1 kJ e' I S,5- -
City Miami Shores County Miami Dade Zip:
Foib/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): � e� 061!�o Phone#:
Address: oi;,_, 'O'2
may_ U )
et-A i f State: t . Zip:
Tenant/Lessee Name: Phone#•
Email:
CONTRACTOR:Company Name: �NC4.Y&P, `-� ������ Ur, Phone#:
Address: wo 2q_ ExvJ,r� c"X&J c7r•
)�bio c%� State• k_1 Zip:
City: It
Quallfier Name: -fes , '`- Phone#: -- -
State Certification or Registration#:C:t' 14-211 `Z _ArnciCertificate of Competency#:
DESIGNER:cArchitect/Engineer:_i�, 3.&,e�i )1,� , Phone#:
Address* / W �b. � Circe City: �•'tun State-4—Z:7 Zip
value of Work for this Permit:$ o Square/Unear Footage of work:
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of work: 2 IJ ��� '4 ,Ill —
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$
IRmsWW24/2014i
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 brach re ill delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commence e m st be posted at the job site
for the ffaat inspection which occurs seven (7) days after the building permit is issued. In th n of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
NER or AGENT OR
The f n strument was acknowledged before me this The foregoing) nt was acknowledged before me this
23 day of ft4Ld4'C 20 Un by , day of �.� �/`r' 20 k(g> by
b ra„ k„-,tat,.V66 o s personal) wn to J'k 9 P1�'a #05' ( 0 .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 nd who did take an oath.
NOTARY PU CQ8 MMES
NOTARY PUBLIC: COMMMM'F.�._ a w8
rvic
. • Feeruwy 07,2017
Sign:
Sign: �
Print: "i i 'fir Print:
Seal: asoma FT,�t0l"Szo Seal:
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ssssssssssss s . ss s ss :aAPPROVED BY Plans Examiner Zoning
dZil Structural Review Clerk
(ftdwW2/24/2K4)