0 Miami Shores Village "7.
Building Department O
R 015 Oil
10050 RUM Avenue,Miami Sime Rorida33138
Ted:(305)795-22D4 Rx:(305)75&N72
INS1311MON UNEPFIONENUMBBR(305)7524049 -5411
FBC2014
BUILDING Master Permit No. fzc I&
PQM IT APPIJCAIICI Sib Permit No. �v((,0- 91
❑BUILDING U f BJURC ❑ ROORWG Q FEMSO v ❑ E MMON ❑FENB NAL
❑PLUMBING ❑ MEHNOkL ❑REUCWOFIG ❑ G NGE OF ❑OW011A71ON ❑ 9iOP
OONTRAGTOR DPAWINGS
JOBADDFES& 479 M t0l"
Qty. Muni Sues Olunty: Mimi Dade aa:
Folio/Ford#. Isthe Building F6storically Designated:Yes NO
Owipanc y Type: Load: O.mtrudion Type: Rood Zone: BRR ll FFE
OWNI3t Name(Fee 9 e Titleholder): 1 Fhone#: (4 b-32
Address: lie -LN l
City: sate: ap: �
Tenant/Lessee Name: Phone#
Email: G
oonrrRAcro>�company Name'
('r1 sZoe-&,Oglee Ph
on 7- � 2 b C 358!
Address: ¢7D D ( S -, - 1 V b 21
Qty: 1 sate: L Zp:
Clusiifier Nom: Phone# 6.
RateOartificdion or Fagistrdion#: 1 O rtificateof Gbmpetermo. (/40600 9
DMCNER Architect/Engineer: Fhone#:
Address: Qty: Sate: Ap:
Value of Work for this Permit:$ ?� Sfuare/Linew Footage of Work: a0
Tyllaro#,work;t j",[°-i' Adcitiop,/;,-( ..,Alteration ❑ Now ❑ PIor/Plepiaoe ❑ Demolition
Dlalficaoionat Work:
a
Sheaf r+c �br bf;' �17r ihr' tile:
aabmitt Fe®$ ' - fmit/F�e$ 1✓��OCF$ CCIVCC$ �
, inning Fee$ 5 -� Ptadon Fee$ a- �'� Ft$ Notary$
Technology Fee$ I d Training/Education Fee$ "°'t6 Double Fee$
Srudural FkrAews$ Bond$ tt
TOTAL FEENOW DUE$ t
(FOise 02/24t2M4)
BonQnd Cbmpan00Nane(if applicable)
BonQng 0ompan00A�em
City Sate Ap
MoM§age LenOsr'ONa a(if applicable)
MorqW LenOqr'DAO�em
Cfty Sate ?p
Application is hereby maw to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
convTieced 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 seared for BILiFIIC RIJMEINQ SCM POOLS
RHWEEj EKXLBF&HIAITB:I$TANK'S AIR00101TICAWIS ETC....
CO N6TSARFIDAVIT. 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
"DARNING TO CO NEU YOUR FAILURE TO A NOnCE OF 00M M B4CEM BVT MAY
FESLJI_T IN YOUR PAYING TWICE FOR IMPF0V8 B*--RT'STO YOUR PR . IF YOU IN S14D
TO OBTAIN RNANCING, ODNSULTWITH YOUR LBVDBRORANATTORNEY BEFORE FECORDING
YOUR NOIICEOFOCNI M B CE M BVT."
Notice to Applicant: As a cordtion to the issuance of a building permit with an estimated value emoeeding$2500,the applicant must
promise in good faith that a copy of the notice of commencement art 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 occas 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.
9ature--- - Sgnatur
OWNBRor AGENT
The foregoing instrurr t was advowledged before me this The foregoing instrument was advowiedged before me this
1 day of ��,.�, .by _day of �6J - .20 16S by
0 u who is*-i.—�h to Ftp^-tL who is personally known to
me or who has produced as me or who hasproduced as
identification and who did tale an oath. � identification and who did take an oath.
NOTARY RJBUQ � NOTARY P1181JQ
Sgn: Sgn:
hint: tok Print: MSadaw, -
*4" MANt1EL REGIS
' PubNc, of
Mm;'L"DAJACOBSonWss�oN,#FF43855 Mi Corrin.E rn Nov.30rxrs:AWM r4,2017
_ ho•D03d87�
Bond94
APPFIOVM BY Raps l5canvner Zoning
Sructural Review Clerk
(FbAsed(024=4)