REV-16-1805 (2) Miami Shores Village
cFX;+4.1
Building
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g Department10050 N.E.2nd Avenue,Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 $Y:
62-4949
FBC 20o
BUILDING R E IMVIU S 0 NS er Permit No.2G•12.14 9--1SQ
PERMIT APPLIC ub Permit No._ Ef2V b-1 k-Im5
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: .3_I q NE LILA 5jrlrz�
City: Miami Shores County: Miami Dade Zia: 39191
Folio/Parcel# Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): ncs Phone#:
Address: ,k-lal NE CA f8rren•
City: KiQm► JInures State: IL zip:331?X
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Oirami- VvNe-- Phone#: • (0qjq-0y)2_
Address: 14040 b1 W_to COuv-1-
City: 0. M1LU1r11 State >FL Zip: L�o
Qualifier Name: 03r1airAd r5 T1.1 as Phone#:
State Certification or Registration#: GRG 12x1 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ ® 0 CCF$ CO/CC$
Scanning Fee$ 00 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 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
OWNER416V CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
27 day of ju"e- 0201(a by 279 day of Jun, ,20 10 ,by
W11Y%4n-% 3QY1*#S ,who is personally known to (Ir to ndp who is rsonally kno
me or as produ D!. *--wn -�1�k 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:
I
Sign: Sign:
Print: Print:
Seal: Suyap'dT.Vasquez Seal: ,� ••� Sim VWun
Fsk
CommMlon # FFDA2611 -� Commission # FF942611
"i`• " B pft December 9,2019 " •"= Egft Dumber 9,2019
• .�`�� BO N Aaron NotaBonded 1hru Aaron
APPROVED BY 7117, Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)