REV-17-1931BUILDING
PERMIT ArTION
❑BUILDING LEGTRIC...
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
RECEIVED
JUL 2 8 '17
111
FBC 20►4s
Master Permit No. _U(1 — l ¥1"
Sub Permit No.1�—�'
❑ ROOFING VISION
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS: qqo A/0/2777 Aty
County: Miami Dade
City: Miami Shores
❑ EXTENSION ❑RENEWAL
❑ CANCELLATION D SHOP
A® DRAWINGS
C42/ 41_.; Iti"
Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type:
OWNER: Name (Fee Simple Titleholder):�2' / `dck, 49,0
Add resss:°L Z l(-
i"/�okjuCStuve 1/'
City: `k c`k �Y State:
Flood Zone:
• BFE: FFE:
O'er
Phone#: L pky.._ 00;3 4L4
Zip: tJ -3 i. )
Tenant/Lessee Name: Phone#:
Email: f 1 CI,Ci tAtujjLA40 t%(« S QJ _ CAvl
CONTRACTOR: Company Name: //-a't (E %) &%ltyl Cct /c---,EV/CES Phone#: 7 ` 2/ o
Address: 6•7 3 s1 �T t (��
City: C Od C5 ` 6 AD State: / Zip: aa032-
Qualifier Name: AJ4,/ l%C�/ l�''9tZ C174 Phone#: ! �G`?99—Z'88
State Certification or Registration #: - /a/0 / SV66 Certificate of Competency #: /26('O4/ 9 ' - •
DESIGNER: Architect/Engineer: Phone#:
Address: City:
Value of,Work for this Permit: $ 'Square/Linear Footage of Work:
State: Zip:
Type of Work: ❑ Addition Cl Alteration ❑ New ❑ Repair/Replace
Description of Work:
s _ 114/ALf'C�or e3 c litr4, o't. Z? ers
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ �'S i O O CCF $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ G • c
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
xAk (A/0,01(4
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of �V
,20 I ,by
who is ersonally to
•
me or wti; has produced as
identification and who did take an oath.
Signature
CONTRACTOR
The foregoing instrument was////acknowledged before me this
/12' 7 day of
Vv , 20 /7 , by
r %/.4>V(t/ /94rC/CC , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC: / 4 NOTARY PU
Sign:
Print:
Seal:
V5- NIP / i
gith a
*#*****#*##*#*******##****#**#####iiONIfii1'004#s4.**####s##******#*********** s*#**s******ssss*ss**yes******
Sign:
Print:
Seal:
B
•ti+r: YAMILKA MERLIN GUZMAN
, � r MY COMMISSION 0 GG045258
EXPIRES February 21, 2021
APPROVED BY
(Revised02/24/2014)
/f
Plans Examiner
Zoning
Structural Review Clerk