REV-16-1327 Miami Shores Village
MAY 17 2016
Building Department , , J�
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20/1/ -tw�
BUILDING Master Permit No.// I' �?a.
PERMIT APPLICATION Sub Permit No ZCY
[fBUILDING ❑ ELECTRIC ❑ ROOFING �EVISION ❑ EXTENSION [-]RENEWAL
❑PLUMBING [:] MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip: > S.('3
Folio/Parcel#:. I- { fo MS--0 Is the Building Historically Designated:Yes NO
Occupancy Type:_DO & Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titigholder): 4d V1% x(11)(0 S Phone#: 2P��)
Address: 13 Ld ote, u
City: l 4 , State: Zip: 3 3l ® ;
Tenant/Lessee Name: —Phone#:
Email:
CONTRACTOR:Company Name: Phone#::$V:� '8 2.3-2-61V
Address: 57LJ 0/SL
City: 6��el d State: 6L Zip: 5 30 rL
�^
Qualifier Name: T—L.�'!✓/�� Al
by/kA� Phone#:
State Certification or Registration#: Lr C ®CO O46 ertificate of Competency#:
DESIGNER:Architect/Engineer: - Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ l m G S Square/Linear Footage of Work:
Type of Work: ❑ Additions �❑ Alteration [:1 New ElRepair/Replace El Demolition
Description of work: tufo V(S Its C A-CC uLA--n dJA/3 FC�Q_ LJ(Aj.0[j..jj
Specify color of color#hhalle:
Submittal Fee$ Permit Fee,$ au, ,:• CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$__
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Re&edo2/24/2014)
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 d construction lien law brochure will be delivered to the person
- tahosepn7perty-issubject-ta-attachment Also,a certrfied copy ," orded natke-of cornrrrencetPr�rsi�rQst 6�pccistodW hejob�ft
for the first inspection which occurs seven (7) days after permit is.issued. In the bsence of such posted notice, the
inspection will not be ap roved and a reinspection fee
Signature Signature /
OWNER or AGENT CONTRACTOR
The foregoing instrument upas acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 116 .by day of 20 tel' ,by
j,/YIS who is ersonall kno o L�� �L� � who is personally known to
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 P BLIC: NOTARY PUBLIC:
Sign: Sign: '/Z -12"
Print: Print
Nm�•K
Seal: CAMILO $A Seal:
MMROINN
* MY COMMI £ W OQ1611t1 FF# 925188
EXPBi 0 1,2818
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APPROVED BY A I Plans Examiner Zoning
"\ Structural Review Clerk
(Revised02/24/2014)