DS-16-2585Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
0 BUILDING ❑ ELECTRIC ❑ ROOFING
Master Permit No.
Sub Permit No.
RECEJ..
FEB 1 4 017
BY.
FBC 20
176
El REVISION 0 EXTENSION 0 RENEWAL
❑PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS El CHANGE OF
CONTRACTOR
JOB ADDRESS: 12:343a L 1 c 1'
CANCELLATION ❑ SHOP
DRAWINGS
City: Miami Shores County:
Folio/Parcel#: [ I n2 26 ', 3 616
Occupancy Type: Load: Construction Type:
Miami Dade
Zip: `413R"
Is the Building Historically Designated: Yes
Flood Zone:
NO
BFE: FFE:
OWNER: Name (Fee Simple Titleholder): c,,�c)GQ�� . ,�1e) ✓t ;tr iaione#: 7���(f �' 22
A
Address: 7 1t 3a- tsG.25s v 141201
City: lfil/it„/tI ( State: p --L
Tenant/Lessee Name:
Email: e9Mcriotho5ar 4h4.6 t `ge$
CONTRACTOR: Company Name: iq8!} ( 2. (. h � , 1 } Phone#: 15l /5/(E
Address: 2 33 C A. r > r b,
City: ,ZA,,eNQ (It( State:
Qualifier Name: /./
v
State Certification or Registration #':
Zip: `�2/ ?g/ leg Phone#: —10 g
Phone#:
Zip:
Certificate of Competency #:.
DESIGNER: Architect/Engineer: Phone#:
Address: City: State:Zip:
_%:Square/Linear Footage of Work:
❑ New N Repair/Replace :'n Demolition
/42 /ask)' 4.1 !'(iid 1' , _ ,
Value of Work for this Permit: $ c5id
Type of Work: Addition n Alteration
Description of W k:• 61.3-4/A/— t lef-/
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 reinspects
Signatur
OWNER or AGENT
The forgoing instrument /was acknowledged before me this
T,14 day off-�"RE)M� , 20 , by
t r' L� 1/. �1(M r�who is personally known to
on fee will be charged. i4-7
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
1IA
010
oilP
arch, o •
„s�, ;,:i ^Marie Sandra Pi
_ wd "'SCom '1;80654
girds: 23,2017
as
CONTRACTOR
The fore: • ing instrument was acknowledged before me this
-, clay of Y.oJ , 20 II , by
lnCho is personally known to
me or who has produced 1' D - as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
tr
`.t,.►ACB uarrrq
Marie Sandra Pierre
a' MCommissiociFP065496
eo: Dct,. 23
'r Lx- , 2017
;;;;;;;;,-0#om WWWAARONNOTARXcom
************************************************************************************************************
APPROVED BY
Plans Examiner
Structural Review
(Revised02/24/2014)
Zoning
Clerk
J4j/MM,4-(, 5 2a65
'Ist h (c n S e
E'CEIVED
FEB 1 4 2017
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