PL-14-1256 Miami Shores Village RECEW D
Building Department artment JUN 16 2014
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 2010
BUILDING Master Permit NoR/ /y.. /,W
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
,P(PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: (6 C N Tty-
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:T 2-136 -001- 000 Is the Building Historically Designated:Yes NO _
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):_ Q D(d iD De-�4 kOs� Phone#:
Address:_ 464 pw k-2- Tay-
City: �Y1> &�w es State: I L Zip: 331 &6
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: !1 V '+-4f hone#-
Address: ,S'-t) 6's C'f
City: iY��Q� State:
Qualifier Name: J®V\ , A ( (] Phone#:
State Certification or Registration M. 1-1 (9XG�f t Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ L Pro a Square/Linear Footage of Work: 2 Z
Type of Work: ❑ Addition ❑ Alteration ❑ New [ Repair/Replace ❑ Demolition
Description of Work:
Id
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ RX -7' 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 Z 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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of co , encement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature i'g at
OWNE or AGE CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
13 day of uy-w, ,20 IL)- by C� day of 20 H7 , by
LnBoldo be L-A who is personally known to Va�` w' ,who is personally known to
me or who has produced 0—,-1 vert°L i o2nif as me or who hLi 6e^y as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: c 1 Sign:
Print: ` � Sof®Mem*- Print:
Seal: Seal: TERESA J SOLOMbN-
Al',, TERESA J SOLOMON '= PAY COMMISSION*EE939936
=•; ooia3
PAY CpMMI$SI9N#EE131936EXPIRES Navembe _201s
(467) ®® P ®N®t�Se +c�.cam
APPROVED BY &-I Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)