REV-16-1351 Miami Shores Village `2`0
Qa M
Building Department MAY � 8 2016
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 1a,- /2/�
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit No. 45
PERMIT APPLICATION Sub Permit NoM 16— j s-1
❑BUILDING ELECTRI ❑ ROOFING 4Gi
EXTENSION ❑RENEWAL
❑PLUMBING MIMECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
l CONTRACTOR DRAWINGS
JOB ADDRESS: —T �✓� �-'
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: �Con�struction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): 0/a" t ccw\S �/C7'i �c ✓W Phone#: 3D' - �-3?7 3y 2e ,
Address:
City: l Y(r1M ( State: Zip:
Tenant/Lessee Name: Phone#:
Email: / gyp/ /I
CONTRACTOR:Company Name: 'G 1 'a �.L�Ci (� �JcF_ Phone#: r7K� ` q-22 5q ,
Address: �n
City: "I / 1 State: Zip: 1 C1
Qualifier Name: cvv�A-F�, Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
O
Value of Work for this Permit:$ 00 Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:z
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ 0 Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
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
whose property is subject to attachment. Also,a certified copy of the recorded notice of comme en ust be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. the obsen a of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. /
Signature Signature
r AGE ONTRACTOR
The foregoing in ru 1meennt was ackn wledged before
me this The fore oing instrument was acknowledged before me this
day of 1� ,20 150 • 'by day of_A{� ,20 �o ,by
who is personally knowli to — I J ?—who' 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 PUBLIC: NOTARY PUBLIC:
Sign: •, Sign: 5
ARES
ae .
'. CO MSION#EE87255
Print: MY Print: ii Ma E
s rob
EXPIRES February 07,2017 "
Seal: Seal:
icor eo+sa lea+sa
Fk+ rserv+oe.ocm
APPROVED BY yi6 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)