RC-17-2787. a.
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
PER IT APPLICATION
BUILDING ❑ ELECTRIC ❑ ROOFING
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
JOB ADDRESS:
DEC,% 2017
�Il
FBC 20
Master Permit No. RC 11-71-1B-1
2
Sub Permit No.
❑ REVISION
❑ CHANGE OF
CONTRACTOR
�7 y� /Ve. /3 Qom.
City: Miami Shores County:
Miami Dade
❑ EXTENSION ❑ RENEWAL
0.CANCELLATION ❑ SHOP
DRAWINGS
Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: _ Construction Type: Flood Zone: BFE:
OWNER: Name (Fee Simple Titleholder):
Address % Yl) %ice / 3
s,4d
City:/ 1/a•t"?
a4/ /fid S
L L..2 n 1nR�
Phone#:
FFE:
Tenant/Lessee Name:
Email:
State:
fl
Phone#:
Zip: 3 3 )3 a
CONTRACTOR: Company Name:
Phone#:
Address:
City:
State: Zip:
Qualifier Name: Phone#:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address: City:
Certificate of Competency #:
Phone#:
State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration
Description of Work: S.---71'4/ C G
New
CAt C L\J I i ii in
❑ Repair/Replace
n Demolition
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
Permit Fee $ CCF $ CO/CC $
Radon Fee $ DBPR $ Notary $
(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 i . p tion which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection wil not ,•e approved and a reinspection fee will be charged.
Signature i// / l(C- ignature
OWNER or AGE T CONTRACTOR
The foregoi : ins rument was acknowledged before me this The foregoing instrument was acknowledged before me this
f J 'C` rr Yf r , 20 i 7 , by day of , 20 , by
who is personally known to , who is personally known to
� n
me or who has produced b r; V'E ( 1 I C*),_rs-s me or who has produced as
identification and who did t
NOTARY
Sign:
Print:
Seal:
PUBLIC:\
n oath.
43V17,, ' ADY PRIETO
•' MY COMMISSION # FF 214031
%s'•.�- a EXPIRES: March 25, 2019
't of 11,,, ` Bonded Thru Notary Public Undenwrhers
******** 3'********************************************************************
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
APPROVED BY
Plans Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)
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7 %r7 /Ve / 3
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RECF 1' r a
EC 2.6 2017
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 ,f-�
FBC�� 1120
BUILDING Master Permit No. JGC FR -Z.489-
•
PERMIT APPLICATION
RECEIVED
NOV2 2 2117
Sub Permit No.
❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City:
%/d /I/e /3 06-e../.?
Miami Shores Zunty:
Miami
Zip: /
Folio/Parcel#: 3 2,OSO Q c}' d Is the Buildin
Occupancy Type: Load: Construction Type: %
OWNER: Name (Fee Simple Titleholder): v Oi i%/ G e
oRe:
esignated:
Address: A 7 /Ve / 3 a c4_(_.—
City i o M i r"A o r C 1 State: F
Tenant/Lessee Name: /�
Email: �-26 .f 1j /C it,Q/0 C:
NO
FFE:
one#:3&.1- lib
CONTRACTOR: Company Name:
Address:
City:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address:
Phone#:
Zip: 33 / 3 r
Phone#:
Phone#:
Certificate of Competency #:
Phone#:
Zip:
City: State: Zip:
Value of Work for this Permit: $ 0 0 l.�' Square/Linear Footage of Work: / 9 J d
Type of Work: ❑ Addition ❑ Alter •n [] New ❑ Repair/Replace ❑ Demolition
—7)'? a / %c -e e,(fer,
t)e&Y
Description of Work:
ho Lirt_
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ f ()Q • GI) CCF $ CO/CC $
Scanning Fee $ Radon Fee $ 2- • 03 DBPR $ 2 • 00 Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ CP3- 60
(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 prope
for the first
inspection
is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
pection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
of be approved and a reinspection f will be charged.
Signatur- Signature
OWNER or AGENT CONTRACTOR
The for g instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of N O V0 Y•" by day of , 20 , by
who is personaill to , who is personally known to
-E( l I lSe— me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
me or who has produced
identification and who did take an oath.
NOTARY PUBLI •
' as
Sig
Print:
Seal:
,.. ;*s
• :vi EXPIRES: November 2, 2020
• oF cv0, Bonded Thru Notary Public Underwriters
Sign:
Print:
Seal:
*** ** **** * * * 4, *4, ****** ****** * * * .1. t * .1, I 4,*****4,**********************************************.1,****************
APPROVED BY
(Revised02/24/2014)
Plans Examiner
Zoning
Structural Review Clerk