RC-15-1884 (7) r
Miami Shores Village
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-DBuilding Department
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1WS0 N.E.2nd Avenue,Miami Shores,Florida 33138
Tei(30S)795-2204 Fac(305)756-8972
INSPECTION UNE PHONE NUMBER-(305)762-4949 _
FBC 20
BUILDING ( Master Permit No.
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RW A��1(�N Sub Permit No. 9�t-3j I
❑BUILDING �LECTRIC ❑ ROOFING ffl"REVISION ❑EXTENSION ❑RENEWAL
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PLUMBING (f] MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: r ' �. r
City Miami Shores County Miami Dade Zip:
Fol<o/Parcel#: I: i is the Building t
tall Desgnated:Yes NO
Occupancy Type:—.' Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simole Tltleholder); Q 60005 d " (A
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w�- 04
Address: �1Z
City: "�� �i �` � State: D p:3 aJ /AF
Tenant/Lessee Nam I Phone#:
Email: @ f
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N �® P4 /
CANTRACTOR:Com__p�Iany*me: �"l /tJ �o Phone#:
Address: �77
City; 1st I L4 �-�/ / State:
Qualifier Name: A 0,:3 4)0 49s-3Phone#• 3
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State Certification or Registration#: (� �� ®� 7 7 Certificate of competency#:
DESIGNER:Architect/,Engiheer. / / ��- Phone#: c = / 3 t�
Address: j a O-6 — IC)CO State 71p; al-50
Value of Work for thi 5 Pei mit:$ 0.0 Square/Linear Footage of Work
Type of Work ❑ j Add�ItIo RT Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Woric 1 e> a/ ���!
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Specify color of color thru We:
Submittal Fee$ I Permit Fee$ 7SCCF$ CO/CC .C7
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Bonding Company's(�Narrrie(if applicable)
Bonding Company's�Addyess
City a! i State Zip
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Mortgage Lender's I'iam�(if applicable)
Mortgage Lender's f ddr�ss
City State 23p
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Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no worts or instaliatio
commenced prior t' the issuance of a permit and that all work wUl be performed to meet the standards of all laws regui
construction in this,jurisdiction. 1 understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, P(
FURNACES,BOILERSi HEATERS,TANKS,AIR CONDITIONERS,ETC....
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OWNER'S AFFIDAVIj * 1 certify that all the foregoing information Is accurate and that all work will be done in compliance wi
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT n
RESULT IN YOU-11
1PAYI-MG TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTI
TO OBTAIN FI ICING,CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORD
YOUR NOTICE F;COMMENCEMENT."
i
Notice to Applicant: As t j'condition to the Issuance of a building permit with an estimated value exceeding$2500, the applicant
promise in good folt i that a copy of the notice of commencement and construction lien law brochure will be delivered to the p
whose property Is su jest{to attachment Also,a ceR)cled copy of the recorded notice of commencement must be posted at the Jo
for the first Ins n a' ich occurs seven (7) days after the building permit Is Issued. In the absence of such posted natty
Inspection will not P approved and a reinspection fee will be charged.
1
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Signature Signature14
_
OWNER or AGENT CONTRACTOR
The foregoi r instrument was acknowledged before me this The foregoing instrument was ac knowiedged before me this
qday of I 20_ ' . ,by _L._ '!' day of Fg---4 ,20 �b
who rsonai known to dot A E A R+ 1 personally
Pe who is nal known t�
me or who has pro�duas me or who has produced a
Identification and�ho did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PU
Sign: Sign,
Print: Print: >; 1~G /
MARCOR LINARES t
Seal: z•: ,' COMMISSION/EE872882 Seal: way ofFrofda
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