REV-17-1546 Miami Shores Village JUN o 2017
,T �'
Building Departments- -- 1
Orr✓� 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 If
BUILDING Master Permit No. 9C I-7— ?'
PERMIT APPLICATION Sub Permit No. ky 11 - 'S96
/<UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
r CONTRACTOR DRAWINGS
�I
JOB ADDRESS: 0 9 Y /0 / r
City: Miami Shores County: Miami Dade Zi �C-�
Folio/Parcel#: !1 1® 3�a� b- 01J— -5 530 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood BFE: FFE:
OWNER:Name(Fee Simple Titleholder): ii PF5 CA � 2l) � ► CpAon� &" 33 ^—
Address: 1490 N ' t�
City: ��. �,p�1 State: Zip:
Tenant/Lessee Name:�tl �I�tJ Phone#:
Email:
m
CONTRACTOR:Company Name:' �l Gi? e%'1���G /�G Phone#: ,�� J� �13�
Address:
City: /�?/moi /� _ State: Zip:
Qualifier Name: �y Phone#: 'ifs
State Certification or Registration#: OS D V b3-5 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ �lS/.�®d® Square/Linear Footage of Work: /',g® -5��
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace Demolition
Description of Work: r-1- 011�7oek�i , - L
.Q 7
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ � CQ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ 'i '�a DBPPR$$ Notary$ on
Technology Fee$( (X) Training/Education Fee$ 'r)- dly Double Fee$ 95
Structural Reviews$ Bond$ 91
TOTAL FEE NOW DUE$ 3
(RevisedO2/24/2014)
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.
a
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 07Q 20 l by C)� day of J �� 20 by
who is personally known to �l� (e1 I^ A,�S'- � olis
p y t personally known to
me or who has produced t lw� � C� as me or who has produced LkCas,T�
�
identificationd who did take an oath. identification and who did take an oath.
NOTARY PUBL NOTARY PU IC:
Sign: Sign:
Print: Print:
Seal: .✓vw`v"
go v� Notary PubliC State of Florida Seal:EWA=Statee of FloridaSindi6Alvate2 fnyCommission FF 156750 F 156750
or�p`� Expires 0910312016ao� 8
APPROVED BY ! �� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
FLORIDA LIMITED LIABILITY COMPANY ANNUAL REPORT FILED
UMENT#L15000084313 Mar 05, 2017
Name: CLIFFS ON THIRD AVENUE, LLC Secretary of State
urrent Principal Place of Business: CC2133963829
1490 NE 103RD STREET
MIAMI SHORES, FL 33138
Current Mailing Address:
1490 NE 103RD STREET
MIAMI SHORES, FL 33138
FEI Number: 47-3998732 Certificate of Status Desired: No
Name and Address of Current Registered Agent:
CLIFFORD,DEBORAH A
1490 NE 103RD STREET
MIAMI SHORES,FL 33138 US
The above named entity submits this statement for the purpose of changing its registered office or registered agent,or both,in the State of Florida.
SIGNATURE:
Electronic Signature of Registered Agent Date
Authorized Person(s) Detail :
Title AMBR Title AMBR
Name CLIFFORD,DEBORAH A Name CLIFFORD,STEPHEN J
Address 1490 NE 103RD STREET Address 1490 NE 103RD STREET
City-State-Zip: MIAMI SHORES FL 33138 City-State-Zip: MIAMI SHORES FL 33138
I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under
oath;that I am a managing member or manager of the limited liability company or the receiver or trustee empowered to execute this report as required by Chapter 605,Florida Statutes;and
that my name appears above,or on an attachment with all other like empowered.
SIGNATURE:DEBORAH A CLIFFORD AMBR 03/05/2017
Electronic Signature of Signing Authorized Person(s)Detail Date
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