WS-13-1201 i
7 ;
Miami Shores Village FY: E_ ,& i
Building Department 8 2017
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �'
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 S�
FBC 20 � 4
BUILDING Master Permit No. WS -7 ,3— 13 :Za
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
QQ ( 1 CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip: 3 S
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: L I Flood Zone: BFE`: FFE: �j Q
OWNER: Name(Fee Simple Titleholder): Car(0 S 5��1 V Phone#: J 2 -(TC
Address: "1 l 22 d�� COKyz�
City: N1 a1r►'�� oR�� State: Zip: 5O
Tenant/Lessee Name: t Phone#:
Email: Ckar l F�2 C? Ck6Lr- I L5 C6LSI(.e S , c-z inq
CONTRACTOR:Company Name: -korr`e O W h�(r Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Cqi C'e 1( SV1
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)
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
OW or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
18 day of ::kIr;t 20 17 by day of ,20 , by
(QrtOS GSA-i Q who is personally known to ,who is personally known to
me or who has produced D C'IV'f V l C`Q.Y�S'� as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY NOTARY PUBLIC:
Sign: Sign:
Print: t'(�r Print:
Seal: Seal:
YANADY PR 0
MY COMMISSION#FF 214031
a= EXPIRES:March 25,2019
Bonded Thru Notary Public Underwriters
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
ED
APR 8 2017
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Miami Shores Village
� ` BuildingDepartment cam'
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Y 312013
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
v Tel: (305)795.2204 Fax: (305)756.8972
INSPECTION'S PHONE NUMBER: (305)762.4949 �—
FBC 20/ �p
BUILDING Permit No.
PERMIT APPLICATION Master Permit No:
Permit Type: BUILDING RO I ,G
JOB ADDRESS:
N/ 3 s,
" ' 33138
City: Miami Shores County: Miami Dade� �� v' / Zip:
Folio/Parcel#: L�!
Is the Building Historically Designated: Yes NO Flood Zone:
x
2
OWNER:Name(Fee Simple Titlehol r� _ Phone#Z
r /
Address: C G f
City: S ISO S'CS State: mic, Qe CK" V Zip: a C
r
Tenant/Lessee Name: Phone#:
i
Email:
CONTRACTOR: Company Name: . CONS1 r b�. Phone#: 7&=, �
Address: till.✓ 3
City: &M 6ROt;E PA4—FS. ate: ;CZ. f Zip: 33OZ(
Qualifier Name: V-44 �. .t Phone#:
• 1
State Certification or Registration#: A/ Certificate of Competency#:
r �
Contact Phone#: Email Addrtess: ZATEX4Z,4C ozfAm:CA N
DESIGNER: Architect/Engineer: Phone#:
6�Value of Work for,this Permit: $ ,. Square/Linear Footage of Work:
Type of Work: ❑Addition ❑Alte don , ❑New ❑Repair/Replace ❑Demolition
Description of Work: P h D�•L v
Color thru tile.
po
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
Bonding Company's Name(if applicable)
_r f
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 ELECTRICAL WORK,PLUMBING, SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 commencem nt must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issue n the a enc such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
e nt—'J ntractor
Tie foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 ,by /V�p(�p < < day of /> 01 ,by t`—l)(.AAM7 n�prL c o,S
who is7pnally known to a or who has produced who 'Arsonally known e or who has produced
As identification and who take an oath. as identification and who did take an oath.
NOTARY PUB NOTARY PUBLIC:
/q '' �```` P•'M• `'''jam
�. ,.• Nor ., -.- ,•` No ., -.
Sign: Sign:
Print: C 1 C.0 /✓1/�:• = Print:
_CP X17 :O
My Commission Expires: A** �oe6 My Commissi' spikes: a OZ
FLO�o` ��ipF•FLO �```��
* * ** ***** * ** ****** *t umf4
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 5%2/2012)(Revised 3/12/2012))(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)