DC-12-1501Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: MECHANICAL
JOB ADDRESS: -64 NC 1.0 101 ST
FBC 2U
Permit No.
Master Permit No.
AUG 072i2
City: Miami Shores County:
Folio/Parcel#: 1 - 213/0 -- 00 r7 - 0 O
Is the Building Historically Designated: Yes
Miami Dade Zip: 3 3 (oS
NO Flood Zone:
OWNER: Name (Fee. Simple Titleholder): 9E art-O ‘•• •
Address: 54 11:10• 101 ST
City: NliV1P41 SO°1V r
■
one#:ii
State: ;j Zip: 33
Tenant/Lessee Name: Phone-
Email:
CONTRACTOR: Company Name: CAp iTkl GENE (244 C &m-A c-TD25
Address: gO 49 • g 4 Sviij BID (o
City:
141(~41E400 f 17 State: R--
Qualifier Name: c lu -. &d 1b
State Certific Lion or iration #: e.'i e._ 1250 / 4P
Certificate of Competency #:
Contact Ph � 5 -g21) ) Email Address: �0 CAplT 1 eN1 2-AlC ATTP- AL7D2S.
DI SIGNER: A r c h i t e c t / E n g i n e e r : 5Pi 1 T i - 64-77,4 i Pt :S/ Ai Clams • Phone#: 3C649 2 '46/4
Phone#: 30S- ig.zri -!c2 ll
zip: 33OIy
Phone#: 30S -87;7- <, Z i®
Value of Work for this Permit: $ 7, I OD. Dv Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ®1Vew ❑Repair/Replace
Description of Work: ZUTT WORK) NEr ..) 14 046-- / ila -Tilt .6 %CGC)
❑Demolition
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
' t onding Company's Name (if applicable)
Bonding Company'wAddress
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 EL ECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 comment must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In Bence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged /7
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this 2(
day of T e l ' , 20 l? , by Peel P..0 4 451 ID ,
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Signature
Contractor
The foregoing instrument was acknowledged before me this 247w
day of Ti)//)/ , 2011 y by (4/2-10S 4. Belk) ,
who is personally known to me or who has produced
as identification and who did take an oath.
"' -"- — — ' -* NOTARY PUBLIC:
4 s,,,,,,,,,, OLGA L. CRUZ
;r° . `i1. Notary Public - State of Florida
0 ) ���! / °.•s My Comm. Expires Sep 23, 2013
- �'' Commission # DD 894805 Sign.
® �A 1. ���'''''�'�'` Bonded Through National Notary Assn. pin mr-
My Commission Expires:
%,3
OLGA L. CRUZ
Notary Public - State of Florida
• My Comm. Expires Sep 23, 2013
w' Commission # DD 894805
Bonded Through National Notary Assn.
My Commission Expires: 0/23X3
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APPROVED BY Plans Examiner
Structural Review
Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06/10 /2009)(Revised 3/15/09)
Zoning
Clerk
i