RC-11-2124 ��r•r Wit— 1
Miami Shores Village 'FIN/ + �
5 sC
Building Department A" 0�.,20�1
10050 N.E.2nd Avenue Miami Shores Florida 33138 B
14
Tel:(305)795-2204 Fax:(305)756-8972 —
/V nV�' INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDIN Master Permit No.led
PERMIT APPLICATION sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PU 'LVV1G(SR12S"''QjFiT�IGE OF CANCELLATION ❑ SHOP
I.RACTOR DRAWINGS
JOB ADDRESS: /V IF lb
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE`:: FFC�E:
OWNER: Name(Fee Simple Titleholder V, —,!)K Le (14VPhone#:_/���
Address: 1/0 l r p
City: State: L Zip: l
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Phone#:
Address:
City: �.FS ate: 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:
0y)("k 1\GH_ Oh O = Z):fyM i A7
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,.... 1
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." A
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement`and"construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection'which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 ,by day of 20 , by
,who is personally known to who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
Seal: Seal:
APPROVED BY I Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
�9m S�sr2
Miami Shores Village WTOW7
Building Department Nov 15 2011
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY:-- ----------------
r_ Tel: (305)795.2204 Fax: (305)756.8972
� J7 4
2_ INSPECTION'S PHONE NUMBER: (305)762.4949
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: BUILDING ROOFING /
OWNER:Name(Fee Simple Titleholder :Vi /IGi S, 1-4 Yj Phone#:
Address: I3 lvt- /1,0 t> -
City: State: L- zip: 3 3
Tenant/Lessee Name: j hone#:
Email: VLA U
JOB ADDRESS: 10 to N G J
City: Miami Shores County: ami Dade Zip: ,7-/11p
Folio/Parcel#: r
Is the Building Historically Designated: Yes NO w ♦ PAP& Flood Zone:
oxhvCONTRACTOR:Company Name: �btPhone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
Contact Phone#: Email Address:
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ SgftkLinear Footage of Work:
Type of Work: ❑Addition ❑Alterationfa,ONew °t Repair/Replace ❑Demolition
Description of Work: 1 �Tr,J ����%' �.( c '�'a f ��r. tY +s
**********xx**Fees***************
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$60 '1-40
TOTAL FEE NOW DUE$
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 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 &.&URE TO RECORD A NOTICE OF
COMMENCEMENT MAV- RESU w,� OUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY'! IF YOU INTEND TO OBTAIN
FINANCING CONSULT WITH YOUR LE'. , R 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 ins ection which occurs (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not ap a reinspe tion fee will be charged.
Signature Signature
Owner or Agent Contractor
The foreg ing i strumen was a 1 dge of re me this The foregoing instrument was acknowledged before me this
day of FW,20 L,by day of 20—,by
is rsonany known e or who has produced o is personally known to me or who has produced
• �1ntification a who did take an oath. as identification and who did take an oath.
NOT PUBLIC: . • NOTARY PUBLIC:
Si p\P*4 0%t3
Sign: 2 1� Sign:
g Pr nt:
Print: Nay
•a r
My Commission Expires: �~ C My Commission Expires:
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)