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EL-18-931 (4)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 FBC 20 11 VA. BUILDING Master Permit No. 12 ( is - 9G PERMIT APPLI TION Sub Permit No. Eu t V - �I 5 1 ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR JOB ADDRESS:/`�C0uy�.,� Folio/Parcel#: I Occupancy Type: Load: DRAWINGS �is the Building Historically Designated: Yes NO Construction Type: Flood Zone: BFE: FFE: OWNER: Name (FeeSimpleTitleholder): Z� Z( TICK Phone#: Address: l ` � " � 7—LI� �`-�A+A+ � �A)CC 1� City: /"�lam/`I ( S/�&C5 State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Compa Address: /2 Name: -47�/QAj77*--5=/t!Gr (( Phone#: `3 l3'1� -�90 3 —tzo / Lam/?— 02C, City: M 1744 T State: Qualifier Name: State Certificatic DESIGNER: Arch' FL Address: City: State: �Z�ipj: Value of Work for this Permit: $ _ Square/Linear Footage of Work: f P "Y� Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Derglition , 1 Description of Work: oi— Specify color of color thru tile: Submittal Fee $ 50 i Permit Fee $ 1✓�®� ®� Scanning Fee $ Technology Fee Structural Reviews $ Radon Fee $ Training/Education Fee $ CCF $ CO/CC $ DBPR S Notary $ Double Fee $ Bond S TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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. r Signature OWNER or AGENT The foregoing instrument /was acknowledged before me this day of /-���C%� 20 by n.ij�a 7uLz�(i , who is personally known to me or who has produced 10 L DI'U��—�= as identification and who did take an oath. NOTARY PUBLIC: Signature W=� CONTRACTOR The foregoing instrument was acknowledged before me this day of /-41 by , 20 l� 61�USc,) Wi"e---Z.. who is personally known to me or who has produced A & ay jnf i;---- as identification and who did take an oath. NOTARY PUBLIC: Sign Sign:(7--S`GL-s� C A--C.0 Print: (�/�L2/-?? C.'GC /J(77 Print: , ?�1a%, Clara Capote Seal: Seal: o�P.,, Clara ap0 e '' Commission # GG176675 Commission # GG176675 `*= Expires: January 18, 2022 =* *= Expires: January 18, 2022 N'' Bonded thru Aaron Notary -,` Bonded thru Aaron Notary sss***s**:ssss*s**ssi�tlk_'+1<`i�*s*sss****ss*******sss**ssss**::::ssss*:ssss**sssssk� lk*s**s*ssss**s**s**ssss**ss APPROVED BY Plans Examiner Zoning (Revised02/24/2014) Structural Review Clerk