REV-16-179 Miami Shores Village
99 Building Department JAN 2, 1 ZQ15
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
BUILDING Master Permit No
PERMIT APPLICATION Sub Permit No.
"(BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade ZiD. '- \
Folio/Parcel#: Is the Building Historically Designated:Yes NO
i
Occupancy Type: Load: Construction Type:�( Fload Zone:--"�/ BFE: FFE:
OWNER:Name(Fee Simple Titleholder):
1 L �-
Address:
City: n-,`, ��'}�<�,l State:
Tenant/Lessee Name
Email: i �_(,T_�, AC�
CONTRACTOR:Company Name: AaC-,;2 �J�{ a✓�y)®�; �-c n.:) Phone#:
Address: ��'�'�,�
City: it State tl Zip:
Qualifier Name: IL� � ��=, N.)/ � 1�) Phone#: .`�- _vim j ZState Certification or Registration#: ��� A®._ ) ?2 Certificate of Competency#:
DESIGNER:Architect/Engineer: L) L, Phone#
Address City ` State Zi '
Value of Work for this Permit:$ Square/Linear Footage of Work: 11`Vi rL jv \�-�e,
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace 4 ❑ Demolition
Description of Work: (V —Z f- A-!;-,C5 C
i
Specify colorof co r thru tile:
Submittal Fee$ Permit Fee$ a CCF$ CO/CC•$
Scanning Fee$ Radon Fee$ DBPR Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews l$ �� ' o-) Bond$
TOTAL FEE NOW DUE$ V `
(Revised02/24/2014)
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 Signature ?J '�
E�z EENT
The foregoing instrument was acknowledged before me this The foregoing instrument owledged before me this
1 1 day of G,ri`+c''. 20_IV, by �_day of 20 by
Cr
who is personally known to who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: `-a ��" � Sign:
Print: P�C�s �- ll� ('1 0 � �iY��'� Print: (-Plf,
Seal: Seal:
TERESA NUNEZ-APONT
TERESA NUNEI-APONTE +°• ;° Notary Public-State of FloriJda
*** ***** : :"' N tar P lic- tate of Florida , •'' m.Expires Jan 26,2
* ** *** * *+ ********** ***** g �k *** •* ******** *
,. .°.,' yommxpires fan �," "1 °P,•` Commission+ ' 33
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q,. Commission FF 086355
APPRO Plans Examiner Zoning
It—
Structural Review Clerk
(Revised02/24/2014)