Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
DS-16-2193
#/7- /tern, 6-o b '/ >" h- i �_y� . a BUILDING PERMIT APPLICATION 0BUILDING 0 ELECTRIC PLUMBING ❑ MECHANICAL JOB ADDRESS: Yb' IBX i 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 O ROOFING O PUBLIC WORKS REC J N 0,8 2018 r� FBC20 '-1 Master Permit No:1) CI 6` 2( Q 3 Sub Permit No. 0 REVISION 0 EXTENSION 0RENEWAL ❑ CHANGE OFC NCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores Folio/Parcel#: Occupancy Type: County: Miami Dade Zip: 331 a) Is the Building Historically Designated: Yes Load: Construction Type: Flood Zone: BFE: NO FFE: OWNER: Name (Fee Simple Titleholder): HO.rl3 A AYIPhone#: N b` -1c7-4 '395� Address: 50\vYti12- City: State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Phone#: Address: City: State: Zip: Qualifier Name: Phone#: State Certification or Registration It: 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 Description of Work: dQ ,.Q ta.. Lit ❑ New ❑ Repair/Replace ❑ Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ DBPR $ Technology Fee $ Training/Education Structural Reviews $ CCF $ CO/CC $ Notary $ Fee $ Double Fee $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ __ y 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 occ rs seven, (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be appr• ed An. reins ..n fee•will be charged. / ,S �.►� Signature O NER or The foregoing instrument was acknowledged before me this Signature CONTRACTOR The foregoing instrument was acknowledged before me this 6' day of J 016.12=-P , 20 I cS , by day of , 20 , by MSA 1\11('I Nom- -4whoo i personally known to , who is personally known to me or who has produced -SL. l'W1 \•Q-)1/4.Ctf\A'S 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: 7v Sign: Print: SI 1\117AA 764.J0 ' E Print: r Seal:Y°oe Notary Public State of Florida Seal: ?° �; Sindia Alvarez r c* ea My Commission FF 156750 or fvocb Expires 09/03/2018 #################################################################################/##########/################# APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 1- ori El\ Ot 0-6nCerg Pepkb_),-)--cn3 Ls -A-E) c�`�-12 3v -�S g -\(c) — Z13 BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC 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 RECEIVED AUG 042016 BY: _w FBC20)1 Master Permit No.Tkb - 21 9 3 Sub Permit No. 0 ROOFING 0 REVISION El EXTENSION ❑ RENEWAL ❑ PLUMBING 0 MECHANICAL 0 PUBLIC WORKS JOB ADDRESS: A -x- (C -''`' ❑ CHANGE OF 0 CANCELLATION 0 SHOP CONTRACTOR DRAWINGS City: Miami Shores Folio/Parcel#: Occupancy Type: Load: Construction Type: County: Miami Dade zip: 83/30 Is the Bui Historica,esignated: Yes NO %C. OWNER: Name (Fee Simple Titleholder): Har 10, /4 Address: 131- &X.,t) 10(25.44' City: State: Tenant/Lessee Name: Email: CONTRACTOR: Company Name: Address: City: S te: Qualifier Name: State Certification or Registration #: DESIGNER: Architect/Engineer: Address: BFE: Phone#: Phone#: FFE: X3/3-963-42 - Zip: 3S/SO Zip: Phone#: Certificate of Competency #: Phone#: State: Zip: City: Value of Work for this Permit: $ /` c) -P 0 0 Square/Linear Footage of Work:' FQC_j Type of Work: n, Addition n Alteration D. New ©. Repair/Replace ❑ Demolition Description of Work: EX -lie ,-ernov — 12 Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ Scanning Fee $ Radon Fee $ DBPR $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) CO/CC $ Notary $ Training/Education Fee $ Double Fee $ Bond $ 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 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 RE RESULT IN YOUR PAYING TWICE FOR IMPROVE TO OBTAIN FINANCING, CONSULT WITH YOUR YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a b promise in good faith that a copy of the notice of comm whose property is subject to attachment. Also, a certified for the first inspection which occurs seven (7) da inspection will not be approved and a reinspection Signature NOTICE !. COMMENCEMENT MAY O YO :' ROPERTY. IF YOU INTEND ER OR L,6‘.ATTORNEY BEFORE RECORDING •ermit w ent an..r'o • py of th the b be c an estimated value exceeding $2500, the applicant must nstruction lien law brochure will be delivered to the person ecorded notice of commencement must be posted at the job site ing permit is issued. In the absence of such posted notice, the ged. The foregoing instrument was acknowledged bef a me this 1 day of -UqU.S�- , 2. 16, by 1'i1Qr' C1 4 . �t�Gl`el,IJ , who is personally known to me or who has produced L ri\ er L C.Ce identification and who did to NOTARY P Sign: Print: Seal: as .4'pY..''''' YANADY PRIETO -4".4 .. ;: MY COMMISSION iY FF 214031 , w? EXPIRES: March 25, 2019 �j'',1e:1; `` Bonded Thru Notary Public Underwriter: APPROVED BY (Revised02/24/2014) Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of , 20 , by , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: Plans Examiner Zoning Structural Review Clerk