REV-16-702 (2) Ell t� ,Miami Shores Village �cEn
�I g �
Buildin De artment M 17. 2016 g p
10050 N.E.2nd Avenue,MAI Shores,Florida 33138 BY:
Tel:(305)795-2 F (305)756-8972
INSPECTION LIN O ER:(305)762-4949— r�
FBC 201 4
BUILDING Master Permit No. 9.4-- 1" 16.200
PERMIT APPLICAT Sub Permit No-y-1-:V I - 6z-
BUILDING ❑ 0 G REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ C I. [:]PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: ^4.7_t WC k O Zw0 Si
City: Miami Shores Countv: Miami Dade Zia:
Folio/Parcel#: 32COO t 715)84 is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):. tA Phone#:
. 2" �
Address�� �j �dd�lnn t ° sss Q
City: mt,oml State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: O`1V1 IA y
Ir Phone#: X05- %6.1900 (7
Address: go �� 1� St
L
City: l WQ L
State: Zip: 33
Qualifier Name: h Phone#:
State Certification or Registratlon* CGC- o Certificate of Competency M
Ab
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 1 "30(3 Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: &,6tju6i2,s t b t ®r` i5appvo6 w Tz) Ga,
Specify color of color thru tile: ��ii
Submittal Fee$ Permit Fee$ "03 CCF$ j V —PO CO/CC$
Scanning Fee$ C&3 Radon Fee$ '-4 •2n DBPR$ -�� Notary$ 5w-(p
Technology Fee$ y �� Training/Education Fee$ Double Fee$ 60 1.
Structural Reviews$ Bond$ filkikst, ,
TOTAL FEE NOW DUE
(Revised02/24/2014) ( o �
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 EUCTkIC, 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 wilt be clone 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
OWNER or AG T C TRACTOR
The fore oing instrument wasacknowledgedbefore me this Theforegoinginstrument was acknowledged before me this
day of ft 20 by 1 day of HaeCj f ,20 ,by
*Ncluf- JL QU Z who is person wn to h h yl tic lout- ,who is p rson—a ly know
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 PUBLI
Sign: s Sign
Print: VUIVA Print: 1 CCS
a� MYCoMhUSSION#OB855 Seal: QUIDA JACOBS
Seal: �s EXPIRES:q�14 20l7 MY COMMISSION#FF43855
EXPIRES:August 14,2017
ARAM
�4
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
S&!IC.I l?
KENN Miami Shores Village
Building Department
R�pp► 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RECEIPT
PERMIT#: l�P ^ C� DATE:—(3/3///
I,
contractor
0 owner
❑Architect
Picked up 2 sets of plans and (other) -
Address: q--7q V J � l Q
From the building department on this date in order to have corrections done to plans
And/or get County stamps. I understand that the plans need to be brought back to Miami
Shores Village Building Department to continue permitting process.
Acknowledged by:
PERMIT CLERK INITIAL:
RESUBMITTED DATE:
PERMIT CLERK INITIAL: