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REV-17-986 (2)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 8 f R 110,D2017 �FBnC 2/0 (14 BUILDING Master Permit No. `� qz� PERMIT APPLICATION Sub Permit No. ?:Ex) �� r ❑BUILDING ❑ ELECTRIC ❑ ROOFING V REVISION ❑ EXTENSION RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 6-15 691'r4C 7 LV H CD (/ ✓'Se City: Miami Shores County: Miami Dade Zip: 7 3 Folio/Parcel#: I f -- S ZO & - of 7 — Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): �r ►v�..� 4 GI �(%� Phone#: �lS� �F9 �/ — �% g% f Address: -!5' k S k0 r�s State: Tenant/Lessee Name: Email C ne#: p: CONTRACTOR: Company Name: Si�-m11��• +Phone#: Ot— 410 O 6 �fa� Address: '-'Y 4 O 3 C1 A V M City: ce C k- Stater Z Qualifier Name: C. te- C— IM ` S �y Phone#: State Certification egistration #: 4 Q C - Efl {p O S� Certificate of Competency #: _ DESIGNE . Architect/ gineer: ► r Arl'L1� l� �1 IP6 C L L Phone#: �o S Address: 3 nAf Z S"F 1" I� City: t"M/er-ti l 5 %ff3State: F�— Zip: 5' 3 3 Value of Work for this Permit: $ Type of Work: ❑ Addition ❑ Alteration Square/Linear Footage of Work: ❑ New ❑ Repair/Replace Description of Work: UIN 1 LFJ F-t-- C-1c } O 4e �6 P� ❑ Demolition Specify color of..,c6llo`rthru tile: Submittal Fee $ Permit Feef$' �S CCF $ CO/CC $ Scanning Fee $ (Z- Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Structural Reviews $ 1 2 Double Fee $ Bond $ 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 nspection fee will be charged. Signature Signature E r, OWNER or AGENT CONTRACTOR :, The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this Z-7 day of 20 �� by , Z7 day of, f b- Ir-L--- 20 *7 ,by who is personally known to ' C�1Lv— \ Id�@ LsR�—wvho is personally known to me or who whhoo has produced V- �• as me or who has produced ' C as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUB Sign: G' Sign: r. Print: `✓0, - 7 Print: ���/4 ��l Ve Seal: *0 Put,LAURA F �' : �P * MY CSeal: MMISSIFF IW7O' LAURAFARLEY "*1 EXPIRES: March 16, 2019 * * My COMMISSION # FF 18M Bonded Thru Budget Notary Servim EXPIRES: March 162019 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)