FW-14-2625 Miami Shores Village
Building Department D E C 0 4
�wnr, 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 N6,FW
PERM ITOPLICATION' Sub Permit No.
BUILDING —ECTRIC ROOFING REVISION EXTENSION RENEWAL
PLUMBING MECHANICAL [:]PUBLIC WORKS CHANGE OF CANCELLATION F-1 SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 490 NE 101 st
City: Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel#: a�v(p- 0Ay;;,C> Is the Building Historically Designated:Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Robert Bourne Phone#: 786-281-8376
Address:653 Grand Concourse
City: Miami Shores State: FL -zip: 33138
Tenant/Lessee Name: Phone#:786-281-8376
Email: robertbourne@bellsouth.net
CONTRACTOR:Company Name: My? IQ Phone#:
Address: Aik.
City:
_VA i _____State: zip:...
Qualifier Name: I y a1j1wcl� Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address:'- city. ^Dr State._Zip:
Value of Work for this Permit:$' Square/Linear Footage of Work: L42,
Type of Work: r_1 Addition ❑ Alteration rM New El Repair/Replace ❑ Demolition
Description of Work: 1K)5(Ai b M TO I U) UJ®L TO 6 1--I E) S"-IK Y. k --
Specify color of color thru tile:
Submittal Fee$ Permit Fee_$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$_
Technology Fee$ Training/Education Fee$ Double Fee$
12—A it
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 LENDEW&AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a bu' ith an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commend 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.
d
Signature :2
Signature '
OWNER or AGENT CONTRACTid
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
I day of
®1O .20 _,by day of IVyc/e,-? 20 1 Y ,by
U� who is personally known to A r ,who Is personally known to
me or who has produced L 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:
Print: Print: y / ���y Ute' seO1 el 1
.�
Seal: ; MY COMMISSION#FF 101399 Seal: KATRINAMENESES
EXPIRES:Ady 2B,2018 =° 6n MY COMMISSION#FF058685
Bonded 7kuNoftry Pu*uneemlors EXPIRES:SEP 23,2017
• 8endeA threuge to s8ete Usutance
ry
APPROVED BY ' Plans Examiner U Zoning
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