REV-16-625 Miami Shores Village
MAR 0 9 2016
Building Department
Y�
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FrrBC j20
BUILDING Master Permit Nor
PERMIT APPLICATION Sub Permit Noll Y 1161,2,�`
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL
❑PLUMBING [:] MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
ldf CONTRACTOR DRAWINGS
JOB ADDRESS: I"1 1 l f
City: Miami Shores 6-0N
- County: Miami Dade Zio:
-
Folio/Parcel#: 1_ -W 6-0 I "I1i7 3 b V Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): G Phone#:
Address: Affq k T61
City: State: -1 L/ Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Phone#: l '
Address
City: I�v� flfl State: Zip:
Qualifier Name: r V Phone#:
State Certification or Registration#: �� Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Permit:$ ` , `b[/V/� .
Square/Linear Footage of Work:
T § µ ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
rk: o r ccvin,n•�e vt w� ��n
Pw1 LA(&I
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ -� CCF$ CO/CC$
Scanning Fee$ ` W Radon Fee$ DBPR$ Notary$
Technology Fee$ Tralning/Education Fee$ Double Fee$
Structural Reviews Q(3 Bond$
TOTAL FEE NOW DUE$ ��T
(Revised02/24/2014)
4a
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 commencement must be posted at the job site
for the first inspection which occurs sev (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a 14i spection fee will be charged.
Sign re ignature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of q C' ,- 20 JC by day of AICA 20 1 b ,by
✓` who is personally known to 4V)'!2- G',who is personally known to
me or who has produced as me or who has produced as
identification and who ' . - identification and wh ^�*e
RAFAELAMORETfI Oe,e. k•:� ,._ ,,.;:
MY COMMISSION t FF 127227 :+ ••,, RAFAEL AMORETTI
NOTARY PUBLIC: _*: ;* NOTARY PUBLIC: 'ia r 7
EXPIRES:May 28,2018 = MY COMMISSION N FF t I22
Bonded Thru Notary Public Underwriters ^ :o` EXPIRES:May 28,2^1 P
9(„• ,�c
BndedT Notary Public Jnde,-r.:a.
Sign Sign:
Print• Print:
Seal: Seal:
################################# #########################################################################
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)