MC-11-1283 (3)Miami Shores Village
Building Department
1 0050 N.E.2nd Avenue, Miami Shoes, Florida 33138
Tel: (305 ) 795.2204 Fax: (305) 7562972
INSPECTION'S PHONE NUMBER: (MS) 762.4949
REarcnnsim
CEP 0 6 2011 NJ
BY:
BUILDING Cm ot 1 e v(9OA/ Permit No. MG- 7— It —1 Zt3
Master Permit No, tf -5 se h
FBC2O
Permit Type: MECHANICAL
OWNER: Name (Fee Simple Titleholder). 31'7,1 Vap,,,resc
Address- t '5 00 41 I: 77i ��-
Citr- * ,ti e Sty: FL
Tenant/Lessee Name• i3. sly the r.erg. ry
F.mar7: ash &arty Ali, i { . tobuq . 1.4.'
JOB ADDRFSS: t 1) t!O ill F 9,74 AUK
City: Miami Shores County Maui Dada
Fo io/Pareel #_ t 121 'i b po ®o d
Is the Buibgng HistorIcidly Designated: Yes NO
CONTRACTOR: Company Name. l'{' L. " =' fit? RK
Address: '2.1%5 c
b
City: •:_ __ �� � r� "fi,�, �� *�� :r:
F!_ ZIP 333/4.
Qualifier Name: .�i , a ,;, � s'� phone*,
State Certrfic ati certificate of Competency F_ l % 3 3G( fi f 9
Contact ` ''q; � '$ '+ t�
Email Address: JA.Ava r5,pit,/ itp bt ,1/ j► ed'6�' • 044
..V eer (;(f yer'K Phone0: Asti -S?.5 7er7(
Phone*. ?stJS — $9q.. 3oSo
zip: 33i(
Phoae#: 30S- 4t 979 -340
zip-
Flood Zone:
PhoneL R 614- 5 Z5- 29`71
Value of Work for this Permit: $ Square/Linear Footage of Work
Type of Work: OAddrest °Alteration urguiAsioA, °New °Repair/Replace °Demolition
Description of Work: ar-- tir_t — e iii'` :L —rif+" t - r.
* * * * * * * * * *# *** * * * ****** * * *#***v **
f *tut#4C0*#?**V** Il sW* #** *# * * *****
Submittal Fee $ Permit Fee $ U" L°CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ TrainingjEducatlon Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
1 V-11
Bowling Company's Name (if applicable)
Bonding Company's Address
City State Tap
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Tip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or ialhWon has
commenced prior to the issuance of a permit and that ail work will be performed to meet the standards of all laws regulating
construction in this jurisdiction, I understand that a separate paint mast be cured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, FTC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done to comphance with all
applicable laws regulating c on nuction and zoning
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IIMPROVEMENTS 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 condetion to the issumsce of a burning permit with an estimated value exceeding $25t10, the applicant must
promise in good faith that a coy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a cert fled copy of the recorded notice of commencement mum be posted at the Job site
for the first inspection which at se yen (7) days after the building permit is assued in the absence of such posted notice the
inspection will not be appr, F a reinspecuma fee will be charged
Signature
Owner or Agent
The foregoing instrument was acknowledged before nne this 6'
day of C /7T , 20 LL, by D. (3.2E
who is personally known to me or who has produced
As identification and who did take an oath_
NOTARY PUBLIC:
Sign:
Print:
My Commission Ecpi
Signature
Contractor
The fo ttoing instrument was acknowledged before me this.50-141
day of I:. ' . 2011 . by M ark. Iter ,
who is perso ( known to me or who has produced
as identification and who did take an oath
NOTARY PUBLIC:
anana tsrVI*reaaee*
APPROVED BY
Sign:
MY COMMON g EEIC93C6
EXPIRES Auguat 2015
00713O153 ocisidailaniraavialeas
ernse ,r xesateoxase**ss.msacsn*a as ae
Plans Eaiminc r Zoning
Structural Revien Clerk
(Revised 07t1W07)(Revised O6/012O09)(Revised 3113109)