RC-15-1884 (8) Miami Shores Village
Building Department JUL o5 Ippla
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
-----
INSPECTION
INSPECTION LINE PHONE NUMBER:(305)762-4949 (A
FBC 20 t Lt
BUILDING Master Permit No. 04:5- V5
PERMIT APPLICATION Sub Permit No. R45V rss`f
❑BLIILDING Fr'ELECTRIC ROOFING EqREVISION EXTENSION RENEWAL
[PLUMBING � MECHANICAL F-JPUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION F-JSHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: A-19 10a
City: Miami Shores County: Miami Dade Zi
Folio/Parcel#: Is the Building Historically Designated:Yes_NO
Occupancy Type: Load: Construction Type:_Flood Zone: BFE: FFE:
P
OWNER:Name(Fee Simple Titleholder): f3AY C*A)&q9&tn ing-7, e b&-V_gL0& ne#: 305— 5:34ze
4r
Address: 2.0/ :n i3!A=1AjAE -&-ab
City: MAa Al I State: P40?-j J>h 33631
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: M&-jWQ C6 1AAr- Phone#: 2A(2-44308S
Address: 16050 U45F 20 Alva
City: M1 b"f -State: zip:. - 331e
Qualifier Name: -004bg— Phone#:
State Certification or Registration#: er-_ 1390-2 .3" Certificate of Competency#:
DESIGNER:Architect/Engineer: -\X>'WV Et A",> Phone#: 1:52!5
Address:..36V LIJ 'ILA 72�-7 1 I= City: 4bLj=x WQbh_State: Zip: w
-3-2 .0
14
V
Value of Work for this Permit: 9100 A r1r. Square/Linear Footage of Work:
Type of Work: ❑ Addition �Alteration FiNew ❑ Repair/Replace ❑ Demolition
Description of Work: � 00 tLt- b std no
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ 17= , dD Radon Fee$ DBPR$ Notary
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews Bond$ j
TOTAL FEE NOW DUE$ C)o
(Rev1sed02/24/2014)
Banding Company's Name(if applicable)
Bonding Company's Address
City State Zip
01 14r —01
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. 1 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 pasted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. in the abse f such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
rtrument
ER or AGENT CONTRACTOR
The foregoing ias acknowledged before me this The foregoing instrument was acknowledged before me this
day of_ L _,20 1/6 by d y of-� '20 _/e --,by
eJ" personally known o wh s personally known to
c - _---.
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. MARC LINARES
MARCOS LINARES
Print Print:
Seal: EXPIRES February 07,2017 Seal: EXPIRES Febaary 07,2017
�so�sa ade-0+53 oaa
APPROVED BY G Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)