RC-16-1922 (2) Miami Shores Village
Building Department 7BY:
UG 23 2016
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 2014��
BUILDING (waster Permit No. Rcv I(,p _ -1-
PERMIT APPLICATION Sub Permit No. _R C 7- /Co - l 9 D3
_,
❑BUILDING ❑ ELECTRIC ❑ ROOFING ® REYLS-1-0-N EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
r�
CONTRACTOR DRAWINGS
JOB ADDRESS: I D 3 0 S AJ2 Ave
City Miami Shores County Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):/SVS . 6 unni e k j A, L)V,4 Waf&aJ Phone#:
Address: /0306 h , F 2 R\fe
City: )�)iGrii 1 S�Vt7Ye S State: Fl- Zip: 3 3/ 3 V
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: T 1 i1 CCC Ye S4 g�YOU Phone#: .3L 5- a5 6-Y 70
Address: ) S(� 7,;� S, LO . '7 3 001(IL
City: ,Gi h') i State: F 10 v'_d et, Zip: 3 3'-5-
Qualifier Name: ;J-uo Al V Az`q u e z- Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: SoSe P, F CiyiL f SArv(+UKaL Ent Phone#: 305 987- 'A'1/7
Address: �Ly DlSi S Spree�- SwP�e ..f- b City: xp_� State: R, Zip: 33610
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New 0 epair Replace ❑ Demolition
Descriptian of Work: 1pp.pr i ruS.s R 2a4 SoFR Su v4 embe
r
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$_ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
at State
Mortgage €-n&C;, a m (if a t,,ror r#$ ,
MGA t 1 i 'r°: address
State
3°i j$$fi£at r Y?3.a'utt?eby r c t Yv, t aj;�,Qf it to do this watk Atte€nate :C frmtclNt at,10��� P t�g� �az3tf iP b
€ d Prfay t thv ,&Ssa R f ] Mit d that f wa lk �VdM a t Tile TMM4,45 of aill fm,41
€rrrI rAwnd that a Separate ter st WW51 be secured to' ELECTRIC PLUMSMO SiGms" P001"s,
FURNA K W:)%fR5,0 A lQSa A fit ,AIR f tf aE ETC,.....
OWNE
W & celtify Wv,allt 4z3" a(Curzite and that eft Yyofk tV,� ,,- dune jP� a���
utt�' 3k}�s3 P ts�tat':S 3o P ed€4
construction, �e ?`x'"g,
"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 WITHYOUR
YOUR NOTICE OF ."
Cn�Mfilt f"t_d MI f 0,rhe applkant Aust
' qw,4141,wrh that a cagy Af the""Ure r a sn p "I low bf0rhure W,11 be def a ka the r~,
hose r��rird rapt'of rho rrrkvpfC
the F> iaspeamn vs3 btc €'JpOtto,nheg huif ;i{ g' Pani"d Ami ,�?� ��M ' ur s $i SUj-, g � xi �
V!.`3E�:rV IN,ampmo°�.'d �a S praf&�r'6�' �Sgd�YdS u��56 ��dd.. � # ..��'`�&. ,00t,i e, i�..
e F
f' Rr, f gt rit lltwas r—kreowfedgehow e,m t-,+tm
Tose 1 mfr £rut �tsa � s t � t ;:
r g, dayo`1
n., n _L �.a _ Y try
-•
�dvnnifit-"Vuo and W�,ovo take an L'40,
art!Whys did talo ar oath.
NOTARYPUBU NOTARV 4
Setif:
low
PRf L gOry PuMk State of F�rirt.a
p1no q� IIJpoNto Romano
Zoning
Expkm 1246019
Bonding Company's Name(if applicable) �/ A
Bonding Company's Address
City State 1 Zip
Mortgage Lender's Name(if applicable) �J 1 /a
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 certif"red copy of the-recarded irotice of commencerrrerrt must be pasted 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.
CSignature Signature
OWNER or AGENTc»n Mun o�v ,L CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of .20 by day of .20 by
.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: Sign:
Print: Print:
Seal: Seal:
APPROVED BY Plans Examiner Zoning
�^ Structural Review Clerk
(Revised02/24/2014)
Miami Shores Village
Building Department AUG 22 za%
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 [B7Y: _
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20N��
BUILDING Master Permit No. Rev
PERMIT APPLICATION Sub Permit No. _P, C 7 -kip
]BUILDING ❑ ELECTRIC ❑ ROOFING ® REVISIO ❑ EXTENSIO � ❑RENEWAL
❑PLUMBINGMECHANICAL ❑PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION E] SHOP
■ CONTRACTOR DRAWINGS
JOB ADDRESS: I C �� .2 A\\,'e-
City Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: / Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): MY- 8
• Ci4�.0 e �'(�I til Fl;Vd WdSo,,; Phone#:
Address: 10 3y�5 /V, T 7 A Ve-
City: )j)lC+171; S State: Zip:
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR:Company Name: ' V C(_Ye S t (,YUC� Phone#: ,3[)E DS 5,Y
Address: ) S�- 7� S: Lc' , ��' o'- f4-
City:Ci � 11'C4 )11 i state: F l c r'd eL, Zip: .J 3
—.h
Qualifier Name: J_UCD til V,4 U e z- Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: SoSt lel Car k i 2 F F c i v i L f SAvv c}i'rca L Ems• Phone#: 3u5 9'y7- 'A`'/7
Address: 2'1 F8-:21 : Spree f City: / mkt L State: F/, Zip: 33 0�C
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair Replace ❑ Demolition
Deseripti'an of Work: -TruSS Re I LaLtati sc,FF'i4- Su v4 wmh,?
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 1 l
(Revised02/24/2014)