DEMO-14-1011 Miami Shores Village � �� �
A
Building DepartmentMAY 2 3 014 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 20
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.D�0 1 H --I Un �
®BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
C NTRACTO.R DRAWINGS
JOB ADDRESS: 2 �� ��L� . a� Ld
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: F/F/E`:
OWNER:Name(Fee Simple Titleholder):1;? 14✓✓-Ci i4�2/��� Phone#: � �. �f
Address:-.?—L30
.
City: '1:. Stater Zip: ,�1
Tenant/Lessee Name: Phone#:
Email: k �(2
CONTRACTOR:Company Name: " 7
Address:
City: State: Zip:
Qualifier Name: Phone#:
ip n
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: 11 City: State: Zip:
Value of Work for this Permit:$ l of Square/linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Demolition
Description of Work: tee- Alz
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$
(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. 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 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 or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
QC1 day of r-N P"`-•C ,20 1� ,'by' day of ,20 by
('r\ArtJ-&l—L4'�mAIA`°'�who is personally known to n = ,who is personally known to
me or who has produced rt— 10'-D as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: \��` 'S Sill, NOTARY PUBLIC:
Sign: _ 03 2010 Sign:
Print: _ s+a��-# Print:
Seal: clj .,EE113059. Q
N� Seal:
OF
r�
APPROVED BY J 7 'Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
COMPLETE • eMPLETE THIS SECTION ON DELIVERY
■ Complete Items 1,2,.an43.Also complete A. Signature
Item 4 if Restricted Delivery is desired. 0 Agent
■ Print your name,and address on the reverse D Addressee
so that we can return the card to you. B. Recei r/ Name) ate of Delivery
■ Attach this card to the back of the mailpiece, 11
or on the front If space permits.
D. Is delivery address different from item 1? E3 Yes
1. Article Addressed to: If YES,enter delivery address below: ❑No
®C)P'1 KC- pts 3 j
3. Service Type
A f�Ceri fled Mail® O Priority Mail Express-
1-3 Y ❑Registered ta Return Receipt
❑Insured Mail ❑Collect on Delivery
4. Restricted Delivery?(E#ra Fee) ❑Yes
Article Number 7009 1410 0000 7001 0 015
`CIransfer from service Ia1
"3811,July 2013 Demestic Return Receipt
UNITED STATES POSTAL SERVICE First-Class Mail
Postage 8�Fees Paid
USPS
1. 11111 Permit No.G-10
Sender: Please print your name, address, and ZIP+4®in this box*
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