Loading...
REV-16-459 EVEO Miami Shores Village 7BY: 119, 2016 BuildingDepartment 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 'S V7 INSPECTION UNE PHONE NUMBER:(30S)762.4949 FBC 20 ( A BUILDING, Master Permit No. �9 PERMIT APPLICATION Sub Permit No. Y�C\) 16! 41519 BUILDING ❑ELECTRIC ❑ ROOFING ISION ❑EXTENSION RENEWAL PLUMBING MECHANICAL MPUBUC WORKS M CHANGE OF ❑CANCELLATION ❑SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1 U ..� N �� `�T(ILL A7 City: Miami Shores County: Miami Dadcz e Zlo: �J FOlio/ParCeW:113 X 5 L)1 � C 1� Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: �Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): io 3 a n} cm- "' S LLC(Phone#: Address: `:C` ,t Csc, D Itiy Q-. : .2c?' City: J�: State: `" (C>CL-'-x Tenant/Lessee Name: Phone#: Email: Y "2b c ` Gu CA"Z2,:Z1 —1 CONTRACTOR:Company Name: cw" L=% Phone#: ���Zl 1-7b Address: I C% 1 1�3 P I C-'t tram ^- City: oeat1 v c� e, a- State: P Lw C,fir-i t Zip: =:3 Qualifier Name: `l�! Phone#:C — ��� State Certification or Registration#: G QC. %-.,.)�e-k%b l Certificate of Competency#: DESIGNER:Architect/Engineer.. Phone#: Address: City: State:�Zlp: Value of Work for this Permit:$ Square/Unear Footage of Work: —r Type of Work: ❑ Addition ❑ Alteration ,[ : New ❑ Repair/Replace ❑ Demolition Descriptio of Work: t r p K9C.pr� _ ��©YC no A o Specify color of color thru tile: Submittal Fee S 0 Permit Fee <JZ-) CCF$ CO/CC$ Scanning Fee$ 3(j"'QZN Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews S Bond$ TOTAL FEE NOW DUE$•�QJ •� (Revlsed02/24/2014) f 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 L achment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the flrst inspection ich occurs seven (7)days after the building permit Is Issued. in the absence of such pasted notice, the inspection will not be proved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR MENUpersonally ged beforeme this fiefor oinginstrume a acknowledged before me this .20 !� ,by day of .20 i ,by lly known to 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 PUBUC: NOTARY PUBLIC: AS g Si n: Sign: ,o�"'"o"�••.,,� ARM r 1 •'o` o m x r Print: Print: Q My C mm.Expires Apr 1,2 Seal SPIN� + Com ss Seal: °j Commission#FF 163930 fill APPROVED #!##Milltliili#ilt!#Mit!###itlt#!!i#i!ll4iiittl#i4ttii#stilt####illi!!######!!#ill#iii#t#li###!ilii!!!!#4#!t APPROVED BY � 1 161%. Plans Examiner Zoning Structural Review Clerk (RevisedO2/24/2014)