REV-18-813Bonding Company s Name(if applicable)
Bonding Company's Address r
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
a �
•
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no worklor 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 ih 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 ' bsence of such posted notice, the
inspection will not be apprthied and a ` 'nspection fee will be charged.
Signature
OWNER o ' GENT
The foregoing instrument was acknowledged before me this
2-day of -� , 20 4 , by
P-8Q QC) t tr3hZii is personally known to
me or who has produced ((--(1( (2_ U` � asC)
identification d who did take an oath.
NOTARY PU
Sign: ,
Print: (NIQ
Seal:
***********************
APPROVED BY
A
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
.P-9 day of IlilN n' 20 i �j , by
t\‘6N0 �1�� p rsonally known to
me or who has produced `[ r`/ �(2".•
identification and who did take an oath.
NOTARY P L'• IC:
Sign:
Print:
• Notary Public State of Florida Seal:
Sindia Alvarez
My Commission FF 156750
xpires09/03/2018 4,,,
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Plans Examiner
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% Notary Public State of Florida
Iss Sindia Alvarez
o < My Commission FF 156750
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Zoning
Structural Review .Clerk
(Revised02/24/2014)
1-00\
Miami Shores Village
Building Department
M R 2 �2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 b
FBC 20 I `-I
BUILDING Master Permit No 1 \C,0 2SO
PERMIT APPLICATION Sub Permit No 10 `813
Olin BUILDING ❑ ELECTRIC ❑ ROOFINGREVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
Q �cyc� CONTRACTOR DRAWINGS
JOB ADDRESS: (r7 dOC) /)L l�� ✓
City: Miami Shores County: Miami Dade Zip: 3 2 138 '
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): TI �� LAID L�LL7,/-"! YL�C . (�Phone#: `7f J '
Address: [ do..tsc 'Pe L IJ r
City: /i / AM ( .51 t-07 ti State: FL- Zip: 33 /32'
Tenant/Lessee Name: • Phone#:
Email:
CONTRACTOR: Company Name: -ii�L %OC CO s7/ZJ Gf (J,/-) " "v Phone#C7K6) g 7 (� V / (
Address: ,3 Qo COG///Js A-V 7 (
City: U I II-N 113E146i% State: re-- zi : 33 I `( °
Qualifier Name: 748n/e.g._ i(,JrJnJE'Z Phone#: 8-6) W77 22 F6
State Certification or Registration #: CSC (52/7 T' Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration
❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: cp,-E'2LfvciA.46 We) A [ % ')7
Specify color, of color,thru tile: .
i t -i . ,. i. ! 'v It.AF,
Submittal�Fee $ " -' Y 01- i' Permit Fee $ C:70 03 CCF $" • ••. • -, •, CO/CC $
Scanning Fee $ �~ . Radon Fee $ DBPR $ •. Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ (45 • 00 Bond $
--eft • 35 • Q TOTAL FEE NOW DUE $ 'R . •
(Revised02/24/2014)