WS-15-434 Miami Shores Village
Building Department artment FEB 27 2015
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10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
F BC 20 Q
BUILDING Master Permit NoLX)-"::� �, �')L
PERMIT APPLICATION Sub Permit No.
BUILDING []ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF []CANCELLATION El SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 5z--4� 'q IC �?
City: Miami Shores County: Miami Dade Zia: >3/3
Folio/Parcel#: ff --52-06-OK- 0260 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): C I Q U]DE- P-0/Z&I e P–S Phone#:
Address: AlE '71 7E P—&Aif ~
City: 6".4947"i- g State: E L Zip
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: l �� �l if�L Phone#:
Address: 'qf 2/ AW -MrA k i(6
City: C®CO rla,- C f–,ee L State Ir L Zip: S3 0'73
Qualifier Name: Yy' 5 L,.,3"v Phone#: 3v 5 X`f 572-6
State Certification or Registration#: C&C 1 SD 0380 Certificate of Competency#:
DESIGNER:Architect/Engineer: It e v Jf k* A,�yC.^ �"fWZ Phone#: SOS 173, 7SE'
Address: /0"'L5/ S �T `® / City: M/61mi State: :PL_rip: -3-3173
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ig Repair/Replace ❑ Demolition
Description of Work: re CP e
Specify color of color thru tile:
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$ 69
(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. 1 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 low brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recordednotice 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 o/owledged
TRACTOR
The foregoing instrument was ac before me this The foregoing ins ment was acknowledged before me this
?_0 day of Ce a ey ,20 ,by �day of R Ina e 20 !� by
f«U Q _,who is personally known tom �l ,who so to
OF
me or who has produced W p� `sex 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:
g
Print: Print:
��pMMCC11 ; MA UEL BAGRAMELI
Seal: •:: 1 �ppF 1NELr1 Seal: e....`!.....
MY COMMISSION#FF091411
1CfCPIRES Fe aa���` EXPIRES February 10,2018
February 10,201a ra,„„„
.. L.1:UIII �7)�.0��
APPROVED BY Plans Examiner Zoning
1311 Structural Review Clerk
(Revised02/24/2014)