RC-15-1884 (9) 12-0 Miami Shores Village a a
p�ew— Building Department JUN ® 92016
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 r
Tel:(305)795-2204 Fax:(305)756-8972 /�Ot/►/'!E J
INSPECTION LINE PHONE NUMBER:(305)762-49494
FBC 20
BUILDING Master Permit No. R-G 75
PERMIT APPLICATION Sub Permit No.aY M -
BUILDING ❑ ELECTRIC ❑ ROOFING CEttEVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 134 t fe- 0 aZ t-
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11 -3205 - Z)2-?>-t)1 60 Is the Building Historically Designated:Yes NO �-
Occupancy Type: Load: Construction Type: Flood Zone: 40&- BFE: FFE:
OWNER:Name(Fee Simple Titleholder):$A""\ Phone#:
Address: 20t S 1916Saon' 4-1'V 'W-2-026
City: -' State: r-L Zip: -31
3 f
Tenant/Lessee Name: Phone#:
Email: /-
CONTRACTOR:Company Name: /moi C A,16 - Cp&3ST?4)CS)OAJ Phone#:
Address: I S;57 LO 1$pA�72 CA fZ
City: pmts State: atm Int i0d Zip: 93 0 2z
Qualifier Name:_ :H0p4 ,q'tQ /4,0 V!0 R- Phone#: S� '�16
State Certification or Registration M 6!5C 1 0 Certificate of Competency M
DESIGNER:Architect/Engineer: "lot- Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 115100 ,tee, Square/Linear Footage of Work: 0;�
Type of Work: ❑ Addition El Alteration 24 New ❑ Repair/Replace ❑ Demolition
Description of Work: t.w WOOD L L,��1 r^.t, �►�-�'l— *,X'S yn!h- "PLA4' X
Specify color of color thru tile:
Submittal Fee$ 0 Permit Fee$ 00- CSO CCF$ I 20 CO/CC$
Scanning Fee$ 9• ok.-+ Radon Fee$ cl• CJ
6 q DBPR$ a� Q Notary$
Technology Fee$ ! , o Training/Education Fee$ Double Fee$
Structural Reviews$ «O •CZ 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 commence ent mus be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the bse ce such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
O�NER or AGENT //C s //NTRACTOR
The foregoing in rument was acknowledged before me this Th foregoing instr mot acknowledged before me this
day of 20 /tp by day of t ^-e_ 20 )b ,by
1110%LO-Plt!� ,who isrs� n to who Is personally known to
me or who has produced as me or who produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: , NOTARY PUBLIC:
Sig Sign: - —v--^ —�
it/{.i tyles_
Print: — Print: i•' �ARCOS LMfARE
Seal: **eanoj
Notary Public Stele otter Seal: WWII
f1AvCOMMISSION 0 EES72602
Michael Robert Jaar EXPIRES February O7,Z017
My Cohn EE 831947 atm
Expirm 09/0302018 oom
041
*************************** ***************************************************
APPROVED BY �I't Plans Examiner
Structural Review Clerk
(Revised02/24/2014)
PERMIT --- -
Miami Shcres Villa e - u
APPROVED BY DA JUN O 9 2016
ZONING DEPT Y/MjY:-
BLD EPT
J CT i O CC UANCE VVITf i f/QRAL
STATE ANL)C tN i f ALiL S AND REGULATIONS
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MUSTINO stucxo.v a
BONDING AGM T PER MANUF.
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