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REV-16-3218r1.111D\kS° BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑PLUMBING ❑ MECHANICAL JOB ADDRESS: City: Folio/Parcel#: Occupancy Type: 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 Master Permit No. ❑ ROOFINGREVISION ❑PUBLIC WORKS Miami Shores Sub Permit No.ETV- /6 --?21)7 FBC 20 (Zc- iz-it-�I93 ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTORDRAWINGS ,7dF1 r9J 7C-/ 3J(53' County: Miami Dade Zip: Is the Building Historically Designated: Yes NO Load: Construction Type: Flood Zone: OWNER: Name (Fee Simple Titleholder): F' ) / -Gt e� Address:4-6oc" ,(,) /3 f Jc [2 /‘'7 BFE: FFE: Phone#: 3VJ—TrZ��'`�� City: State: Tenant/Lessee Name: Email: 'SC /45h--r-le c h +)4c i Phone#: Zip: 331 �3 CONTRACTOR: Company Name: Ly Address: C) i Cr - City: Qualifier Name: 21.543"U0711 ar �{rr ,r z r-' State: Luis Phone#: Phone#: Zip: State Certification or Registration #: CG C / 1/ 2 1 s--+ Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: . Zip: pjQ- Value of Work for this Permit: $ /"�w ' -0 `Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration❑ New //_1❑ Repair/Replace El Demolition Description of Work: �e%;si DY... .is .40 S t• u --r-/ exit/ 4,5 " \ .1 ©„3 S CY'. .:=Z4olf%J US1\\ her CV•C+rtg ah er- Oc l\cSv',c\ d � 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) '360\v -0g \cA"°' BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC 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 C NOV 2 8 2016 BY 9- S�1 FBC 20H Master Permit No. ec- 1 Z /r 2cf /4" Sub Permit No. (0- J? ?-115 REVISION ❑ EXTENSION RENEWAL ❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRA ORS J� DRAWINGS JOB ADDRESS: V" itC� Y Aari °��/-� F/ 33/ 3 s City: Miami Shores Folio/Parcel#: Occupancy Type: County: Miami Dade Zip: Is the Building Historically Designated: Yes NO Load: OWNER: Name (Fee Simple Titleholder): Address: City: Construction Type: Flood Zone: �}S 7 c\ C'or PP 58500 /3 ri 5 /01 BFE: FFE: Phone#: `3p 1 (-j 2 ^ L% State: Zip: 33)33 Tenant/Lessee Name: p _/ Phone#: J C PE.S ��or \C N ' C4711c j I• i�pr`` Email: CONTRACTOR: Company Name: Address: 30 -I bI Q (-1-) City: UUOs Qualifier Name: State: v� s \f% (--.! State Certification or Registration #: C- 6C S7 DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ Phone#: Phone#: Zip: Certificate of Competency #: Phone#: City: State: Square/Linear Footage of Work: Zip: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Z c \t,4 fy .�Wdi 7'4C.rj s are_ -E4.42_c- rem. - s - 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 reinspection fee will be charged. Sign OWNER or AGENT The foregoing instrument was acknowledged before me this day of / a) , 20 /y , by day of 41111- ,20 / , by j 1174 elf,/, ior1J , who is personally known to ()% S /% 6b l% /> , who is personally known to Signature CONTRACTOR The foregoing instrument was acknowledged before me this me or who has produced as me or who has produced as identification and who did take an oath. NOTARY P Sign: Print: Seal: '''' ',,,/ Bonaea through National Notary Assn. ******************************* ** APPROVED BY (Revised02/24/2014) identification and who did take an oath. NOTARY PU Sign: Print: Seal: IA IMEIDY CERTAIN •t Notary Public • Stats of Florida s Commission 9 GG 008785 My s Oct 3. 2020 Bon �► ! ►_ �J��/fir ougn Etnmrr�•�� ******************************************************************* Plans Examiner Structural Review Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING CRITIQUE DATE: 12-03-2016 PERMIT NUMBER: 16-3218 The description of work on the permit application does not reflect the plans provided. Provide a description of work on the permit application that reflects the actual work to be cover under this revision. Ismael Naranjo, BO, CFM Building Director.