WS-17-2198#3.kfe t .-
o
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS
JOB ADDRESS: a?0 /a ,54 -
i OCT p 2 2017
I
FBC 20
Master Permit No. l
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF
CONTRACTOR
417ATION ❑ SHOP
DRAWINGS
Zip: 33/3?
City: Miami Shores County:
Folio/Parcel#: l --. Q S --(W -0030
Occupancy Type: Load: Construction Type:
Miami Dade
Is the Building Historically Designated: Yes NO
Flood Zone: BFE:
OWNER: Name (Fee Simple Titleholder): I`..la r k_ jua n (Co Phone#:
i 0
City: i%.ZIM I
i State: I -"i
Address: ! d2 0
Tenant/Lessee Name:
Email:
FFE:
�. Phone#:
CONTRACTOR: Company Name: N4,, C.:, Z _ ^�, '�� 1 _ � : �, V � a,
���=` �L?�`'0 u; `..�-; � � Phone#: `� � �
Address: 1.3-st�c \ C1 1-1-k O 'T t•-.) _
_ --�
City:lr�.-yL.� C.�; lr� ���t� �t if\ State: Zip: "3'3 / a.
Qualifier Name: �� ►lf1 E fir` �' i i S Phone#: -jam£ I _,jam .
State Certification or Registration #: 5 0 Cir�-..� � 1 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
Descripti n of Work: �1cQ I peirn
i1.-er
❑ New ❑ Repair/Replace ❑ Demolition
SP.P_ ct heC,t
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews$
CCF $
DBPR $
(Revised02/24/2014)
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
s
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Lp
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation ha:
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....
OINNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with al
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAI
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTENC
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 mus
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the persov
whose properly is subject to attachment Also, a certified copy of the recorded notice of commencement must be posted at the job sit(
for the first inspection which occurs seven (7) days after the building permit is issued /n the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged
Zip
Signatu�
OWNER or
The foregoing instrument was acknowledged before me this
02a day of SPS - , 20 , by
Jig dy)P S - .DavI,S , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC
ANGNG
MY COMMISSION FF 951069
EXPIRES: April 12. 2020
Bonded k: c'ud;m Notary Sernces
Signatu
CONTRACTOR
The foregoing instrument was acknowledged before me this
_
day of 5 e „ + . , 20 / 7 , by
JA VYl e S 1 ,)06 ✓(J , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
S
Print: •
Seal:
NGE OUNG
MY COMMISSION 4 FF 951069
EXPIRES April 12. 2020
eon94d Notary Seriices
*****yc►+ **********1+******** F************ P*******iii***********#*************************************a1 *******
APPROVED BY
(Revised02/24/2014)
Plans Examiner
Zoning
Structural Review Clerk
J & G Carpentry Inc.
13461 79th Ct. N.
West Palm Beach, F133412
561-855-4052
561-855-4054 fax
September 22, 2017
Miami Shores
Building Department
Re: Permit # WS -8-17-2198
To Whom It May Concern,
Please be advised that we would like to cancel/close permit #WS -8-17-2198 for customer
Mark hanico located at 1280 NE 102 St. Customer has cancelled and J & G Carpentry
has done no work at this site.
Should you have any questions please do not hesitate to contact our office.
Sincerely,
James D. Davis
STATE OF FLORIDA *COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me
this e) a day of S e ,20 /
Who is personally known to m4 and who did not take an oath.
Notary signature
Notary printed name
ANGELAYOUNG
MY COMMISSION 4 FF 951069
EXPIRES April 12. 2020
6onocd nru Budget Notary Services
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION UNE PHONE NUMBER: (305) 762-4949
BUILDING
PE MIT APPLICATION
BUILDING ELECTRIC ❑ ROOFING
Ej PLUMBING ❑ MECHANICAL PUBLIC WORKS
JOB ADDRESS:G10 ,\ Xi 5�. ` ''fl
.RECEIVE®
FBC 20
Master Permit No. INS
Sub Permit No.
❑ EXTENSION
❑ REVISION
❑ CHANGE OF
CONTRACTOR
®RENEWAL
[i CANCELLATION ❑ SHOP
DRAWINGS
�����1 _ `,�i j�=
� _� l
City: Miami Shores Cat'I ��'Miami Dade L'?,/A: .�1��
Folia/ParceiR: 3 Q,5 -• Z) � ,_ • 6 Q 3 0 Is a
1� Buil • ngistoricaily Designatiii-,y4seh NO
Occupancy Type: Load: Construction Type: FI • od Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 1v1C\C KV�0Phone#:
Address ` cto t t
City: �`-'\ ► O i l 5 ,,� State:
Tenant/Lessee Name:
Email:
33138
Zip: 3315'
Phone#:
CONTRACTOR: Company Name:
Address: a* -5A C '7 T- t t A"
* �r�G �C�V' Phone#: (- ��' V01 a
City: to 1L Qck..\ 1°iv\State:
Zip: '3'3 ! �
Qualifier Name: �C.4:York e a t) L LS Phone#: /5t. I -.g'S-5- (t/I-S-Q.
State Certification or Registration #: 0 0 r�A� t� � ) Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ --1--63--1-k-i 14
8/. 97
Type of Work: ❑-, Aid, �ii ni t,- Alteration New [Repair/Replace
;r ^Y� Irr
Description of Work. l }-x{ 9,/ ,' Cha \A d, ric K to c L,i i
Square/Unear Footage of Work:
❑ Demolition
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 $
(Revised02/24/2014)
TOTAL FEE NOW DUE $
r ,0,
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 ha.
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulatini
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 al
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MALI
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO Y yR PROPERTY. IF YOU INTENC
TO OBTAIN FIN,
ANCING CONSULT WITH YOUR LEN' '' OR At ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building r` it with an estimated value exceeding $2500, the applicant mus,
promise in good faith that a copy of the notice of commence e , and construction lien law brochure will be delivered to the persor
whose property is subject to attachment. Also, a certified cop the.tecorded notice of commencement must be posted at the job sit(
for the first inspection which occurs seven (7) days afte , ' building permit is issued. In the absence of such posted notice, th(
inspection will not be approved and a reinspection fee l charged.
Signature
OWNER or AGENT
4474 /. trvoicir v
The foregoing instrument was acknowledged before me this
al 9- day of �I�,Iy , 20 11 , by
�k �IL�anico _
who is personally known to
me or who has producedROL-352r1900 as
•o-ao-aoli
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
*dem k.
A olo � Notary Public State of Florida
Naadene A Molina
V e: N t My Commission FF 982658
I4 aow Expo 04/17!2020
******** ******►*************************************************************
CONTRACTOR
The foregoing instrument was acknowledged before me this
�.J
day of ON , 20 ) % , by
s10/MY's D. Poi, 3 , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Signe
Print:
Seal:
ANGFCSIJNG
FF 951059
U+ _-�< E �a .3..4J^ 12.2020
hdgetNotary Sernces
APPROVED BYf ��� Plans Examiner Zoning
IReeicadn7/74/70141
Structural Review
Clerk