REV-16-1321 KNX
Miami Shores Village � �
g MAY 17 2016
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tqssem
LE7NESiUC(N2. 949
FBC 20 I`l
BUILDING 4WkMft Permit No.
7BUILDING
IT APPLICATION Sub Permit No. ®0\( —❑ ELECTRIC ❑ ROOFING �EVISION ❑ EXTENSION F-1 RENEWAL
❑PLUMBING ❑ MECHANICAL F-]PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
NO
1 A CONTRACTOR DRAWINGS
JOB ADDRESS: I C/�d�y225 I VO S Ale
e
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: (�` QL(,2 I a(n Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titlgholder):_t1 �_ piy:�D;2� Phone#:
Address: was tj( 5 AV&—
City: t t(A'M( SWjffe S State: -T—[a Zip:3�12:1a
Tenant/Lessee Name: Phone#:
Email:
'®J L_ R
CONTRACTOR:Company Name: Ys� CO LD Phone#:
Address: n� l
City: IVIM M 1040,f State: -'L Zi
Qualifier Name: U��` ')Uwyly- Phone#:
State Certification or Registration#: I���C,I52 30(0 f Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ to Square/linear Footage of Work:
Type of Work: ❑ Addittiio�n;� ❑ Alteration ��pp ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: ���
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ co CCF$ CO/CC$ '
Scanning Fee$ „Lp Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
(
ig
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
whoseproperty-isstfbject-to-attachrrrent.-Also;v-certifred-copy of the recorded notice-of-commenCenremt rr►ustrtse 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 appro reinspection fee will be charged.
Signature 11 Sign ture
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this Th oregoing instr wa acknowledged be f r me this
day of �f,/ 20 / 4 by �i da of 20 by
FO H PIPE (ZA i 8 ,who is personally known to S who is persona y known to
me or who has produced as me or who has pr duced as
identification and who did take an oath. identification and ho did t e a oath.
NOTARY PUB IC: NOTARY PUBLIC:
Sign: „ Sign: wn
Print: Print:
Seal: h a Commiftbe 0 ff 1121A3 Seal: got ;r P0e4o IA A
(!firough National Nrrary psi MY rrt4M1.%I0N#FF 184276
F''P! .: .0mmber 17,2018
ay�O rt°��OP Bonded Thru budget Notary Sefft
******************************** **** ** ******************************************************************
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)