EL-14-1304Miami 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
rrF��B��,,C 20/0
BUILDING Master Permit No.,�,TLe-- 11-1-130 �.
PERMIT APPL ATION Sub Permit No. - %9-
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
JOB ADDRESS: q2 f
DRAWINGS
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11 JAUS- 0a % OS -10 Is the Building Historically Designated: Yes
Occupancy Type: Load:
Construction Type: Flood Zone:
BFE:
NO
FFE:
OWNER: Name (Fee Simple Titleholder): /9-6 6l') /92 d C_/2M C-6 Phone#: —06S' S?R q /q (
City: /77/dM) Shi r2(L&K
/ State:
f--e-A
Zip:
Tenant/Lessee Name:�A
Phone#:
Emlil: AL-.A—M EA (-ta
CA ifo/Yt
CONTRACTOR: Company Name: Ld 5
_ CCA 9-
Tc'.S
Phone#:
Address: 7C>3,9',' ter), e-&®.At9
L
City: _A y ew 7- u RA
State:
r—
Zip:
Qualifier Name: P.S. s7z;i
V"geju
C eQ&+I°S
Phone#:36s— c;br. S Sof,
State Certification or Registration M 46:. �ef:)®6 3 17 5' Certificate of Competency #:
DESIGNER: ,'Engineer: Phone#:
Address:
City: State: Zip:
Value of Work for this Permit: $ / , �iS—®� ` Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
Description of Work:
Specify color of color thru tile:,
❑ Demolition
Submittal Fee $ Permit Fee $ X�'" CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
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 proved and a reinspection fee will be charged.
i
Signature Signature
OWNER or AGENT CONTRACTOR
rmi 4M4-f--&M,5-t,
The foregoing instrument was acknowledged before me this
day of-Al't , 2.0 %CZ , by
w is personall own to
me or who has produced as
identification and who did take an oath.
NOTA
CASSANDRA N NEBBIA
�•; •`c MY COMMISSION # EE219=18
Sign: ' .. EXPIRES JuIY 25, 2018
Print:
The foregoing instrument was acknowledged before me this
12— day of
/� , 20 � 5e . by
wh is personally known to
me or who has produced as
identification and
NOTARY
Sign:_
Print:
did take an oath.
MY
u •Pl':,; EXPIRES Duty 25, �1®
Seal: Seal: (407)39"im
2e, ly
APPROVED BY 1E Plans Examiner
Structural Review
(Revised02/24/2014)
Zoning
Clerk