FW-16-20332O33
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
0 BUILDING 0 ELECTRIC 0 ROOFING
PLUMBING
sTh
FBC 2014
Master Permit No. c"W 11 2(.23
Sub Permit No.
0 REVISION 0 EXTENSION ❑ RENEWAL
MECHANICAL 0 PUBLIC WORKS 0 CHANGE OF 0 CANCELLATION 0 SHOP
CONTRACTOR DRAWINGS
• ---/L ��(tl
JOB ADDRESS: �' ' f
City: Miami Shores
Folio/Parcel#: Is the Building Historically Designated: Yes
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
County: Miami Dade
zip: 3 3/0
NO
OWNER: Name (Fee Simple Titleholder): Cll. I` �; � a // Phone#: ° ^0 y C%?7
/ JUL / 'o c4
Address: I �,�- I �(�
City: ill, s(& t She' s
State:
f L Zip: 33//
Tenant/Lessee Name: Phone#:
Email: (A)' f ( 11-‘4‘6r4a5 (� 4%%%L4�
CONTRACTOR: Company Name: NOVnt W nr, 1 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 n
Description Work: PieC-i
(,v (6
Alteration
❑ New E Repair/Replace
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 $
TOTAL FEE NOW DUE $
(Revi sed02/24/2014)
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after th building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reirlspection fee will .e harged.
Signature
Signature
OWNER or AGENT CONTRACTOR
The�foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
}
Will,1 day of NOV42-Mlae ' , 20 l , by day of , 20 , by
it 1l 1011 S • G t t1‘ who is personally known to , who is personally known to
t
me or who has produced f �11'? 49 .., as me or who has produced as
identification and who didxakean..Qath. identification and who did take an oath.
NOTARY PU
Sign:
Print:
Seal:
LIC.
YANADY PRIETO
MY COMMISSION # FF 21.1
EXPIRES: March 25, 2 1
Bonded Th;u Notary Public Underwriters
****************************
*****
OM -
NOTARY PUBLIC:
Sign:
Print:
Seal:
******************************************************************
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
��r IT-, JO1c)
P(ex15��1/1L,C �
) , )\j t I u 'P
r jiC-i &vu 5 n 01- 466-.<e_. // ,.€ 1 ka$
/0 ih-7
evkx-e fin uko
NO 21 2017
CPaik:
\7.4 s'C° 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 5 t1
FBC 20 11
BUILDING Master Permit NoE til
P MIT APPLICATION Sub Permit No.
2016
B'
0
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
q j,, CONTRACTOR DRAWINGS
JOB ADDRESS: 4-J-" - N-' Ito
City: Miami Shores County: Miami Dade
Folio/Parcel#: Is thuildin storically Designated: Yes NO
Occupancy Type: IQ, Load: Construction Type: loo. one: BFE: FFE:
UVILI
L,Wr`J l 2r1/ #-9 slG-s5J-BB91
OWNER: Name (Fee Simple Titleholder):
Address: ) 10- 1\l€ 1 I D-14-1- ST
City:YY1 I p /T-1 I S - S State. Lo � f t� Zip: 3 3 I C 1
Tenant/Lessee Name: Phone#:
Email:
Zip: 331c
CONTRACTOR: Company Name: Lt)
Address: (c;- t 1IOt#f
S
city: /Y) i r Yn1 S HW S
State:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: L Phone#:
Address: City: State:
,o 1z l D A
Phone#: ��t! �� 5 33
Zip: 1
Value of Work for this Permit: $ J 5 k .
Type of Work: ❑ Addition ❑ Alteration
Zip:
Square/Linear Footage of Work: 12610 Ongli)P 4
❑ New Repair/Replace ❑ Demolition
Description of Work: f J'(;Q /Yan .4n, Cyr -A . JLF,etc c( frnt - ,4- C&,1V CI
Lv.-c- Gti-lZ L )-ZD �-V&o � `1'Th' elt r..etL., j 1.1x Lit7,p-t e,atvz.e aj-ecificL
k /ra0 ire" %.e `-Lae& a .4-14-0 10 of t amc-f
Sp cify c color thru tile: �
Submittal Fee $ L-=---)..�' rJ� Permit Fee $ 1(J v - CCF $ /J CO/CC $
Scanning Fee $ Radon Fee $ ( ,C:-.), DBPR $ c •W Notary $ "
,-,
Technology Fee $ Training/Education Fee $ V Double Fee $ 9D
Structural Reviews $P Bond $ (� 1 (\
TOTAL FEE NOW DUE$ GO
(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
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
-.-�. )n day of
Et %7r',na ,bC t+7 , who is personally known to
me or who has produced -0V N e r LI LV y� as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
The foregoing instrument was acknowledged before me this
V`-1 , 20 I ( � , by day of , 20 _ , by
I , who is personally known to
NOTARY
Sign:
Print:
Seal:
a1 �
•
YANADY PUO
MY COMMISSION !; FE 214031
EXPIRES: March 25, 20'
Bonded Thru Notary Punic Ur:Serrrl.c'.
APPROVED BY
(Revised02/24/2014)
NOTARY PUBLIC:
Sign:
Print:
Seal:
********************************** ************
Plans Examiner
Structural Review
oning
Clerk