RC-15-2497 5 Miami Shores Village
U Building Department SEP 3 o 2015
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 2014
BUILDING Master PermitNo.eC- t5- 2`Q
crq
PERMIT APPLICATION Sub Permit No.
G26ILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF [:] CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: /Z3� N C /6Z 401.5 f
City: Miami Shores County: Miami Dade zip: 3313e
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): VCAOr rG. 0001 'FC-11< Phone#:
Address: 1230 NoF /OZVC/S 1-
City: 6fgo ` .54o�eS State: �G- Zip: `3 3138
Tenant/Lessee Name: Phone#: 7,06- ZaC 5-524
Email:
CONTRACTOR:Company Name: __r M C 6 Phone#: 898 4Zd "X99 C
Address: lit N E t54' Sf'G&Je-
city:_+/ "dM State: FL Zip: 3313 Z
Qualifier Name: A-7'R1C'9 el'U50-j Phone#:
State Certification or Registration#: LZ /SG9/.317 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: El Addition E:1 Alteration El New Repair/Replace ❑ Demolition
Description of Work: If'-
Specify
� F.�,,,,-i✓ �o.��r., C �aJ�asleL�alr ��� � 7',�f
Specify color of color thru tile:
w
Submittal Fee$ Permit Fee$ � • � CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
f
Bonding Company's Name(if applicable) k4
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable) r-s Ik
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 aftWiLe building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee w g
Signature Signature
OWNERorA T CONTRACTOR
The foregping instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
�® day of d+P—V-'i r ,20 1.5 by �� day of � 7��_ 6y� 20 L.55 ,by
141& who i ersonally known 0 ��;�3�o who is ersonally know t0
me or who has produced as me or who has produced as
identification ' oath. identification and who did take an oath.
NOTARY PUB �;4 ERIC T PITTS NOTA
co . ............ ERIC T IFzi
y, i•�o•,. MY "MISSION#EE1 f o'
( .............. oPIR S February 14 1 1
2016 . gS, t' MY=aryld
N Eifr3
o� #1= 047
Sign. ? Sign :.11
Matzo O:G3 Service co.r
Print: Print: �a
Seal: Seal:
APPROVED BY I /`° Plans Examiner / � '! ) Zoning
Structural Review Clerk
(Revised02/24/2014)