DS-14-1604 zoo
Miami Shores Village CPL
JUS
Building Department 2 2014
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972 ----__
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 201
BUILDING Permit No.
PERMIT APPLICATION Master Permit No�l
Permit Type: BUILDING ROOFING.
JOB ADDRESS: d 0 6 3 y Re t® el-
City:
GCity: Miami Shores County- Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated:Yes ��'1 l�a Flood Zone:
(Fee Sim le Titleholder: NNA Z•Z ��
OWNER:Name p ) Phone#:
Address: `®(0 3 N G l0 pt
City: 81AA41 H®Yec State: I L Zip: 331 39
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Phone#:
Address: nffiftah
City: state. Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Cemficate of Competency#:
Contact Phone#: Email Address:
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ ® Square/Linear Footage of Work: 1 . 200t5,
Type of Work: DAddition OAlteration l ew URepair/Replace ODemolition
Description of Work: AVC-hs .Di2i1/iff WA eomorzenF Oftf0c FAV Fru ov�
Color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
17
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
a
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
commencer) 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 ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 FA TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PRO 0 IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH Y ENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF je► NCEMENT."
Notice to Applicant. As a condition to the issuance offaa 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 ill be charged
Signature tte
Owner or Agent Contractor
The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before me this
day of �V V�,20 1y,by tZ440 4LL,. day of .20_,by ,
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Si ` iw��►nnitui/���ii
Sign
gn: :
Print: ` ,c) o �_•.•.9�5 Print:
My Commission Expires: o y w --= My Commission Expires:
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APPROVED BY r �' �Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)