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RF-15-2768 (2)itkAr 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 BUILDING PERMIT APPLICATION ®BUILDING D ELECTRIC 12rROOFING PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: Ci 5 25 N. d ts.y 5lno re- OCT292015 rY: so4 FBC 20)q CANCELsL Master Permit No._ t3' 2IU2 ❑ "REVFSION r XTENSION ❑RENEWAL it No. RfrS -- 2768 ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Folio/Parcel#: — 32_05 — 0 2 7 — Miami Dade Zip: 33 .3 a Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): e2A4 Ast- Phone#:('3OS)2O6 -Z%S Address: q2 2 A B4 ..S,4e/Gc: 3:) City: if/ f i}rz1 i S'/-i-D/L.‘%S State: , ,F -L• • Zip: 33/3 Tenant/Lessee Name: 'AAA, h+1 p Email: (')C4-SSo(4 �7%gd �41..:2-c--.6"4 CONTRACTOR: Company Name: A R fi tit Address: CK , 13 l �,.. �. City: (.c' c cam\ S 4) r'i my State: T (— Qualifier Name: D+ Qt C r kYCS,Ac Phone#: i t4 Phone#:g5'1- "12- 6 LI State Certification or Registration #: DESIGNER: Architect/Engineer: 'TOO of C/ Gout -T Address: tt q Nt fi 53) Value of Work for this Permit: $ 66 8nc) , 00 Type of Work: ❑ Addition E Alteration Description of Work: "NS.\. Zip: 3 3 06 7 Phone#.(ciVi 22 - b 4 9 G Certificate of Competency #: CC; 15 117 9 J?bone#: (1 5) Gcl City: PI!' 161 % tat r zip: Square/Linear Footage o'f do c: 1),450 s4 } 3 • ❑ New SR w DOJ4RM .b ^ti ::s3°Y 1,,!A,, eci tifibi ^of' or th e 1 itl cis,-...; hut+ {>} lit�f misty.: v. •.,� r ��:' ❑ Repair/Replace ❑ Demolition 0 IA cr, Fla v (;c. ;� (AC \ c -v n // T LLQ S iii*SI ' 'S .,rrimcfermit Fee $ 303� Scanning Fee $ q Radon Fee $ `�1' • r 4,44 Yti1eit 1' 04141• :+'.iRJ4 y fi'i3o j°+s i t C iSSSS;y t1 nolvtimino s iIS> •oi ��r F d 1.., , ,yy �N 111 i"F�nie .,+r DBPR $ e() Notary $ Technology Fee $ "C� 'Q30 Training/Education Fee $ l (.`--10 Double Fee $ 0{ Structural Reviews $ .0"-1 50 ,G0 po ' Bond $ }v (Revised02/24/2014) i e4e- fr � ©� TOTAL FEE NOW DUE $ iZ� • ao `� /) Ci 54f(--C-,`cen - Bonding Company's Name (if applicable) Bonding Company's Address City 1'1 Iry State Zip — Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 3 1 i Application is hereby made to obtain gaa l�.` a d installations as indicated. I certify that no work or installation has commenced prior to the issuance of a`•ermit 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 ars "bf t'hti'f ,torded notice of commencement must be posted at the job site In the absence of such posted notice, the for the first inspection which occurs seven (7) days a inspection will not be approved and a reinspection fee wi Signature OWNER or AGENT Jefgijsued. 4. The fore oing instrume t was acknowledged before me this day of 'ej�4/� , 20 1 s , by .e.:/' ,4• e9,0O// , who is personally known to me or who has produced •yy"""'""" identification and Zia NOTARY PI LIC: Sign: Print: Seal: caa, p�u as - JOSE J. (IIRALOO Notary Public • State of Florida Commission # FF 228273 My Comm. lapiros Atm 31.201• Asstt. **********#ski#�k APPROVED BY _.y (Revised02/24/2014) 1'4 i4 Signature. , *,�rsr NT ACTOR The foregoing instrument was acknowledged before me this )6I day of /®_ leAt , 20 l�/r, by r/f . /IV4'/�A , who is personally known to me or who has produced 0,1,0136,36Vr7-D as identification and who did take an oath. NOTARY P P Sign: Print: Seal: LIC: * ************** ski Plans Examiner Structural Review MIR JOSE J. GIRAL00 Notary Public • State of Florida • Commission # FF 228273 My Comm. Expires Aug 31.201• Sones NOW i ** Zoning Clerk