REV-16-1325 Miami Shores Village _
' De artment
SAY 11 2016 j
Av i ores Florida 33 i
MUN P (3 ]BY:
FBC 20 L`l �
BUILDING Master Permit No. g C —`
PERMIT APPLICATION Sub Permit No
❑BUILDING MIELECTRIC ❑ ROOFING 0?(REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: ,L2 0k /_ C V/y -�`yy,:eT
City: Miami Shores County: Miami Dade Zip:
Fol(o/Parcel#:_,&- -3Zy 0 .10 ® /'10 is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: HE:
OWNER:Name(Fee Simple Titleholder): '�l� k&&/fW4( 6ne#:(305)
Address /j e 11'q sem/
City: State � � Zip: 3-2-7/3
Tenant/Lessee Name: Phone#:
Email: /A� /-,� ' (�P� -- --
CONTRACTOR:Company Name: Cot—zikk - 05A- `CIS-� Phone#: 5y ,,
Address: PW 1 3 / AV C
City: d1 d` a'�✓�'�' //e:��g y State: �Rr�� ZiD: 3`3®z
Qualifier Name:7�?°�.> C'' �.L,� Phone#:()>`�!
State Certification or Registration#: 1300 56 2 j Certificate of Competency#:
DESIGNER:Architect/Engineer: Phkit) R gL4, Phone# �50) "?4.r-3q1 q
Address: 6 �Slol-) '&r 5-inc:- City: #.I/j44/ State: Zip:3 11-3
m�
Value of Work for this Permit:$ POMA Square/Linear Footage of Work:
Type of Work: ❑ Addition LSI Al eration ew ❑ Repair/Replace ❑ Demolition
Description of Work: R a axv c- rid J C ;'pt J .1
art . . F f �
Specify color of color rre tile: 51
Submittal Fee$ -''Permit Fee$ ��owo CCF$ CO/CC$
57
Scanning Fee$ 3 Radon Fee$ �� DBPR$ 9• P Notary$
Technology Fee$ 2. 2-0 Training/Education Fee$ ®' C-® Double Fee$
Structural Reviews$ Bond$ G
TOTAL FEE NOW DUE$ I r
(Revised02/24/2014)
Bonding Company's Name(if applicable) ___.a_--••-••-- ------ -._.__.._....
Bonding Company's Address.
City - State - - Zip m----
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.-tisa;-a-certified-copy of-the:esardedrralice-of-commencemtlnt- mu5`t-&-poste-d—aUfh-joie
for the first inspection which occurs seven (7) days after the building permit is issued. In the absencelo,sucklbosted notice, the
inspection will not be approved and a reinspection fee . be charged.
Signature Signature
OWNER or AGENTN CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
1C�t day of LLNrnJ 20 by day of 20 t by
who is personally known towho is personally known to
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 PUBLIC:
Sign — Sign:
,ow „�
Print, r�"" `B. J AL ERTO BRUGO Print:
Notary Public-State of Florida
or-RTO RR1111-9
Seal: =N, Qra My Comm.Expires Jul 15.2017 Seal: s.• •.= Notary Public-State of Florida
'%"•,'Fo�F Commission#FF 195 ;, aQ; My Comm.Expires Jul 15,2017
"soil �'%'440P F Commission#FF 195
nnua
APPROVED BY l /�by/io Plans Examiner Zoning
Structural Review Clerk
(Revmsedo2/24/2014)