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BPP-12-1158 W-nif.9 �Jk IJUN 9 scawOr�,� Miami Shores Village G6 i2 Building Department By:__.------- ----- 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762A949 C 20 BUILDING Permit No. LOW)a.-"1)15K PERMIT APPLICATION Master Permit No. Permit Type: BUILDING LA;LVEOOFING JOB ADDRESS: i / 8 ;5 #j8 31,-4- � r City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: I I -`��5 •OO I '0-:a©C'-) Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): TOL-,q d CA Address: 32 Z 7 City: &) Y- f E ye- State: FL- Zip: 3:33 -1-9, TenantlLessee Name: Phone#: Email: CONTRACTOR:Company Name:?no L[:r l �5C M 10 NJ hone#Qa� p-4 1 (� Address: 9009-3w City:f4i-a M A, � State: �� zip:�31 tD 5 Qualifier Name:�M-)a� �� ,, 1,-T-2Q quA(�i Phone#��)Qr - - State Certification or Registration#: _ Certificate of Competency#: I I&aa,2 I Contact Phone#(33 ��ED'� f Email Address: Er I 6 DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ 20.,QCQ SquareJLinear Footage of Work: 3 (1 Type of Work: OAddition < OAlteration ONew 13Repair/Replace (]Demolition Description of Work:-SULK l r ryr 1 c� �j Color thru tile: s� Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ fj TOTAL FEE NOWTE '00 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, ust be secured for ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOII ERSI EATERS,TAI 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged �'" ii Slgnature� Signaii Owner or Agent Contractor The for oing instrument was ac wledged befo e is The fore oing instrument was acknowledged before me this day o 0 1�Ol`,by66Fday of 20 ,by �t1 0I-rC� � who is naliy tcnown to a or who produced wh s rsonally kno � me or who has produced - I identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: S`9e�00F otida 2015 ,�. ZAPATA Sign: „� � eP 23' Sign: ' ° MY Comm on#EE My Comm.Expires Sep 12,2014 Print: =r• S1 °la(y Print: p�V Commission #Et 25344 My Commission Expires: ';;�qtE f.,o ' gondedjh�0u� My C F h� 7c1$ d Through National Notary As f,], APPROVED BY " Plans Examiner Zoning Structural Review Clerk Z- (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)