FW-15-2901 Miami Shores Village . C,KIVE
Building Department SEP 2 12017
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FrBC 201
BUILDING Master Permit No. 1 ' 2-010 1
PERMIT APPLICATION l Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ®CANCELLATIO
CONTRACTOR � G� -
JOB ADDRESS: 171 5 WE I OSS 'SA-.
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: p/ FFE:
OWNER:Name(Fee Simple Titleholder): ni . Q i C. i M akD Phone#: �&1 5c sL 1 b 1
Address:-1 a"5 N q—
City:CC)l a n'1 i 5v-\n ces State: �C� Zip:
Tenant/Lessee Name: IjvfQQ,,,IdH�#�.
Email:
CONTRACTOR:Company Name: 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: 77he re 'vs no C !
' C e..7 j ,i r rye ci l .CSI- rN bJ�
i-t l.e �G r GPcA 2C1 .
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. 1 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 qP— Signature
WNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
/21 sT day of 01 .20 1 -7 by day of 20 ,by
A6i 0161 DIG)( Umowho is personally known to who is personally known to
me or who has produced 6/ejor? eA S'syor4- 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:
t: Yl fTi "I Print:
Seal: oNPA—y cein
.o<� p. JENNIFER DE ARMAS Seal:
Notary Public-State of Florida
Commission#FF 175737
�i`a� *&i2Tin**E�g�ts** iig4
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
r
RECEIVE® C�)9
SEP 21 2017
Anna f uuA O/a� ° F w ( s t�` vo as
%we
Miami Shores Village
Building Department NOV 1 7 015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 54q
FBC 20 i�
BUILDING Master Permit No. l - 2go
PER IT APPLICATION Sub Permit No.
E3tUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [—]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: /L/6
City: Miami Shores County: Miami Dade Zip: / �'�
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: //j Le Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): J v ®Pe#PU 0/1,
Address: v 10
City: � /t ��J� C3 State. 1 Zip: 2s
Tenant/Lessee Name: Phone#: / �� ��441
Email:
CONTRACTOR:Company Name: 0LVAtli 2. Phone#:
Address: - r 1 i
City: State: f' � �_I� �,u i�
Qualifier Name: Phone#:
State Certification or Registration M 11_ II Cificate of Competency M
DESIGNER:Architect/Engineer: l n �`, 1 L� 1 ti Phone#:
Address: City: State: Zip.
Value of Work for this Permit:$ uare/Linear Footage of Work:_ A2 ;t7
Type of Work: ❑ Addition Alt ration New `/kepair/Replace ❑ Demolition
Description of Work: 7'�eote v' �e��✓t TSG! 9
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 estimat lue exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement and constru W. brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the reco mencement must be posted at the job site
for the first inspection which occurs seven (7) days after the buil�i g J sued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged,
Signature Signature
NER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of f (���_ ,210 by day of ,20 ,by
AOpti so y known to ,who is personally known to
44h 0 Q&, tubme or who has produced FJ 11446&/_c, l7i'I b'.,(/ S as me or who has produced as
identification and who did take an oath. t;jCPI identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign Sign:
Print: Print:
Seal: I Seal:
YUDELYS MAMMA
MY COMMISSION#FF914084
EXPIRES:AUG 30,2019
an
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)