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EL-15-2404 I 1 Miami Shores Village :SEP 2 L21015 Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 �1 I INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING Master Permit NOWD E�- PERMIT APPLICATION Sub Permit No.T-71— t 5 ❑BUILDING Q ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL F—IPLUMBING ❑ MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION ❑ SHOP d15 CONTRACTOR DRAWINGS JOB ADDRESS: 8745-SW 4 AVE RD Cites Miami Shores County: -f L Miami Dade Zip: 33 1--3S Folio/Parcel#:11-3206-046-0880 Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):ALFREDO JIDY Phone#: Address:1312 15 TER City: MIAMI BEACH State: FL Zip: 33139 Tenant/Lessee Name: Phone#: 1171 Abk—' Email: ,,n (� t�I-y-�^ CONTRACTOR:Company Name: Awe n W� 05/. A' Phone#: / T�©Qo ae Address: .j3 t 21 City: �LA( 7rl"N< state: Zip: QualifierName: 'A Phone#: State Certification or Registration#: X-C- d- CP © 3 Z� Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address City: State: Zip: Value of Work for this Permit:$250.00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of work: INSTALL KITCHEN OUTLET Specify color of color thru tile: Submittal Fee$s® "� Permit Fee$ /,�i0f> 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) r 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 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 commt be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. n the absence of ch posted notice, the inspection will not be approved and a rein ection fee will be charged. e' Signature Signature OWNER or AGENT CONTRACT The foregoing instrument was acknowledged before me this The foregoing instrument was ackr'owled/dbefore me this to day of 20 14 by day of e.F 20 ,by kniRC' �1 l7�1 who is personally known tor, o is personally known to me or who has produced as me or who has produced as identification and who i n oath. JUi.IAN A CARDONA identification and who did take an oath. NOTARY PUBLIC: ,4 ' N"y Puplic-State of Florida # Comatiselon N FF 191910 NOTARY PUBLIC: sn �o�g My Comm.Expires Jan 21.2019 �it�� S0r&..d thr8*Ns eld Notary Assn. Sign: 'Sign: L Print: ? Print: Notary Public State of Florida Joanna MFelciano Seal: Seal: Joanna M ciano My Commission'FF 082753 E%.fJ Expires 01/12/2018 ��S�k��dS9+k+k3&#8k��&k�i#k�&k�8��rldde&Ak k��k k k��k�#+�d8ffiffifik&�&ffi�&H&&$8�&B4fi4kswF��&&N HH�kB fld&&+kaaa&kbk k# kaN dM APPROVED BY ��.�_ �'S t°�L5 _ Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)