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REY-16-2861BUILDING PERMIT APPLIC Miami 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 RECF'T\TED OCT 20 016 FBC 201q Permit No. 1C -2i& 4 ?, Permit No. R Ey 1Co Z1(0 BUILDING ❑ ELECTRIC ❑PLUMBING ❑ MECHANICAL JOB ADDRESS: City: Miami Shores Folio/Parcel#: ❑ PUBLIC WORKS )ti H6 q6 sem, ❑ CHANGE OF CONTRACTOR ❑ CANCELLATION [] RENEWAL [] SHOP DRAWINGS County: ' Miami Dade Zip: Is the Building Historically Designated: Yes Occupancy Type: Load: Construction Type: Flood Zone: BFE: OWNER: Name (Fee Simple Titleholder): H 10 f1 -El . Loog_p FS TorAi4-( 4 Phone#: Address:2 4 jJ City: Tenant/Lessee Name: t\)/ State: NO FFE: Phone#: 13R Email: CONTRACTOR: Company Name: JVC,(9 Co -i44.4.• ��1-i . Address: 102.9q HE City: 1-10,`64.4A; State: fl_ Qualifier Name: LAST ' Phone#: mss 89Z 6 S 07 - Zip: Phone#:O58'- C S'47 -- State Certification or Registration #: CCG )SD S) G3 Certificate of Competency #: p DESIGNER: Architect/Engineer: t Pt cipc4 ?i3 Phone#: �t/_,5 7,S j i' City: V iq/l/Caiel State: Zip: 1.52 Square/Linear Footage of Work: Address: 3 / NL q Z Value of Work for this Permit: $ Type of Work: [ Addition Description of Work: El Alteration ❑ New El Repair/Replace ic c, �/c--, -, ;L a/), Demolition •v a.� 0 rent_dj)\ Specify color of color thru tile: Submittal Fee $pp Permit Fee $ 9- S CCF $ CO/CC $ [? Scanning Fee $ ( Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ -_f_ Bond $ (Revised02/24/2014) oma• TOTAL FEE NOW DUE $ Z I • Bonding Company's Name (if applicable) 0/141- Bonding Company's Address 111 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 reinspection fee will be charged. Signatur ` = Signatur OWNER or AGENT The foregoing instrument was acknowledged before me this lei day of set9-u rn bg-- , 20 IQ) , by iP Puchodewho is personally known to The foregoing instrument was acknowledged before me this :�-ci day of 3CQ-1 n-)bc(, 20 ((.o , by Le s 2v- J ensevi , who is personally known 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: Sign: Print: Seal: Sai)LQ Q( GC( (V,,) c ;IP At:DFLA t soc DFJL" ,\ , RLS . ti 21,;.317 APPROVED BY (Revised02/24/2014) NOTARY PUBLIC: Sign: Print: Seal: Plans Examiner SIOC_AC CLAC nYU P-2.71 P":111-, { 41 Er ,:S: Jt. 91, 231 r Zoning Structural Review Clerk