MC-15-1623 (2) L.. Miami Shores Village
1 4BY'
2015
Building Department
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 16/
BUILDING Master PermitNo.Mcj(S— IG23
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL
❑PLUMBING [MECHANICAL [—]PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I I L40 we I cn aTpi e j qq
City: Miami ShoresCounty: Miami Dade Zip: 83 2
O
Folio/Parcel#:I 1 .32M -0)I`7//��-0 1430 Is the Building Historically Designated:Yes NO
Occupancy Type:8r- R Load: i� Construction Type: Flood Zone: BFE: FFE: ` c
OWNER:Name(Fee Simple Titleholder). -99 YILelIVrejp� Phone#:1 L]12)
Address:111-I O ir1C 1 OO T
city:00_-TJE MM �1.7!ME5 State: r=L. Zip: (�V I a,97
Tenant/Lessee Name: I Phone#:
Email:
CONTRACTOR:Company
KILL)
Name:(��,1�� 1../�.�oi'7� Phone#:(��U.CI I 01
Address:1011-6 L) 1Ib Lk)( l'E M G .
City: MEDLEV State:v:', . Zip.831"l
Qualifier Name: COI1IRILL//��� L E(1 X Phone#:ao5sFc(b t ' I '�
State Certification or Registration MO.Pall a l-1`L15 9 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: —City: State: Zip:
Value of Work for this Permit:$a 6 V 0 Square/Unear Footage of Work:
Type of Work: ❑ Addition El Alteration El New (/ Repair/Replace ❑ Demolition
Description of Work:
Cri
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ 0 L ° CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ Z
(Revised02/24/2014)
4
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 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 will be charged.
Signature Signature�64L .4 4
NER or AGENT CONTRACTOR
The foregoing instrument was acknowledged beforemethis The foregoing instrument was acknowledged before me this
�—day of J L&J .20 16 ,by _day of JLJ f)(--- .20-',155 --�.�by
�� s r I -0 is personally known to Ing O�� I SCwho s personally known to
me or who has R U Ced as me or who has produced as
identificatio �ii ,'�i identification and who�o yan
i FF142531 ,� •• e'% C'1'1Y1 U'17f1CC1'9�
NOTARY P ' .. d�`O� EXPIRES:Sept 15, 2018 NOTARY PUBLIC: _ COMMISSION fF142531
OF www. 110 Copt . ES: Sept. 15, 2018
www. aop�oT�aY.com
Sign: Sign•
Print: Print:
Seal: Seal:
******************* ***** ********* **** ***************************************************************
APPROVED BY . 6 QExaminer Zoning
Structural Review Clerk
(Revised02/24/2014)