REV-16-968 c10I
'ami Shores Village
ding Department APP I 1016
` 050 N.E.2nd Avenue,Miami Shores,Florida 33138 ---
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 �)M
FBC 201q
ING Master Permit No. Re--
PERMIT
CPERMIT APPLICATION Sub Permit No-au l(o-
\Z/BUILDING ❑ ELECTRIC ❑ ROOFING (REVISION ❑ EXTENSION E]RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
^� CONTRACTOR DRAWINGS
JOB ADDRESS: �d ff'o ®U /49 ZS z 517 —c�
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO _
Occupancy Type: Load: Construction Typen Flood Zone: y BFE: FFE:
OWNER:Name(Fee Simple Titlpholder): �i�+ :rte t� -3 us hw Z&/r phone#: 3 0.�— 7
Address: 6 a 'e r 6)/' 7"
City: /&V/ -5/7 0 t I S State: 4 L Zip: 3-5
Tenant/Lessee Name: Phone#:
Email:_1ZLi2oy a
CONTRACTOR:Company Name:� v/c�� 2S l '9J C. Phone#:
r
Address: /S (.41
City: Z2 fState: Zip: d
Qualifier Name: D d/V 1 :L & '9-12 C f A Phone#: �c) -5-6
State Certification or Registration#:ed?C ,f S"/lP,2 •} 7 Certificate of Competency#:
DESIGNER:Architect/Engineer: r ct TG r2 /3,12 J cC Phone#: -e,--
Address:
Address: :�2' 2!V 'N-f' f 0 /S' City:I4�/3/4,41SState: "eL Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addi�ion ❑ Alteration r' ❑/New ❑ Repair/Replace ❑ Demolition
Description of Work: ✓I i-T t L✓r}/v 1F U I '�/a,-L,
Specify color of color thru the:
Submittal Fee$ Permit Fee$ C)O CCF$ CO/CC$
Scanning Fee$ IZ '63 Radon Fee$ DBPR$ Notary$ 0�J
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 PALING 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 property4s subject-to attachment.-Also,a-certified copy of the-recarded notice of commencement-must be posted at the joie
for the first inspection which occurs seven (7) days after the building permit is is In the absent such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
OWNER or AGE CONTRACTOR
Th foregoing instrument Was acknowledged before me this The foregoin strument was acknowledged before me this
day of 20 by day of 2 by
`�� who is p ovally k o (I t_�c• ,who is pers ally wn 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:
111RIIIIIq�I/�
```,%N%N �•pRLE/y/S���i�ii /lam] .
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Sign: a chA, [
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Print: : �� n—frig.
I Seal: 0>f j y l •• •; Notary Public-State of FlWwlda
dD MyCommission S Fes e15288218
*%jATE OF F,QQa��� ''':;s�o .•�' pr t�ipal Notary Assn
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)