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REV-16-2791BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC PLUMBING ❑ MECHANICAL 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 ❑ ROOFING ❑PUBLIC WORKS Master Permit No. Sub Permit No. RECEIVED OCT 142016 FBC 20IY' fixe I b '37b R2?c! ❑ REVISION ❑ EXTENSION ['RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 00 ZS E SA -1^ 5 -1 - City: Miami Dade Zip: 331 3d Miami Shores County: Folio/Parcel#: IV 32Ov 013 ^ 17.00 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: (y Flood Zone: OWNER: Name (Fee Simple Titleholder): --0SG P� Pa ---(2 vrc Address: 10025 NE S4"" STR.E&t BFE: FFE: Phone#: 3- 375-7-1Z lq City: PI 1/A1-^ S i't0(-6:S State: — Tenant/Lessee Name: Phone#: Email: --s-m1-5-iiik-v) 9 £Od''A Zip: 33 (38' CONTRACTOR: Company Name: 7`-123 St.,..) Address: iu rr olJfit «ooL pQSi IN N kuE Phone#: 3- S90-- /626 City: M State: Qualifier Name: (iZc:0-600 o dQt State Certification or Registration #: Cf" DESIGNER: Architect/Engineer: Address: City: Zip: Phone#: Certificate of Competency #: Phone#: State: Zip: Value of Work for this Permit: $ JPS Square/Linear Footage of Work: �1 Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace I i Demolition Description of Work: top'— 11:54-‹ AA -1-.0N.) S� 5-ra -A j2 j t o Specify color of color thru tile: Submittal Fee $ Permit Fee $ G3 S CCF $ Scanning Fee $ Radon Fee $ DBPR $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 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 reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this � %d day of be o , 20 t� , by /D day of QcT ©� ) R- , 20 —Qh ?t?e17.4173 , who is personally known to rites 3d w i\f Z , who is personall me or who has produced �L as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Signature CONTRACTOR The foregoing instrument was acknowledged before me this identification and who did take an oath. NOTARY PUBLIC: Sign: � Sign: Print: m t a • Print: Seal: ..�w� p �,., Seal: ;,�` 1s;,,, MARIA THERESA PINO 1 Notary Public - State of Florida ��, if Commission # FF 15368 APPROVED BY (Revised02/24/2014) !a as 442 1-9142,‘A _f'! ,'\P"V °w'•, MARIA THERESA PINO : Notary Public • State of Florida I •1 Commission # FF 15368 ********************>I **w' i � nk*A11kCetni ki isisseid ar#*21)1# ** Zoning Plans Examiner Structural Review Clerk