EL-17-1723Miami 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 agrECTRIC ❑ ROOFING
Master Permit No.
Sub Permit No.
EXTENSION 0 RENEWAL
0 REVISION
0 PLUMBING 0 MECHANICAL 0 PUBLIC WORKS 0 CHANGE OF
CONTRACTOR
3C ' / 100 S�ret
JOB ADDRESS:
RECEIVED.
FEB 1.5 2018
FBC2OEI
201'7 - l71-3
CANCELLATION 0 SHOP
DRAWINGS
City: Miami Shores
County: Miami Dade
Zip: 3 3 ) 3 S
Folio/Parcel#: 11 3 LO (o 0 (3 ) Li 1 c .
Occupancy Type: Load:
OWNER: Name (Fee Simple Titleholder):
Is the Building Historically Designated: Yes NO X
Construction Type: Flood Zone:
vI
Address: SA Inn c 33 9 b0 Y+ --
2 /4111 IJrj Mai uvoS
BFE: l FFE:
Phone#( o r) 4 • 6 oq
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Address: 1 4
B✓ 11 O —d L=ave 1 h e_
Sw
I "t 7 ft• Tcxt .
Phone ?at.) q foL}
City: A -4-10-w"- i
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: ...a41t„ State: Zip:
r�
Value of Work for this Permit: $ Square/LineaFootage of Work:
Type of Work: ❑ Addition ❑ Alteration r'.
❑New;;:;L ❑Repair/Replace ❑Demolition
Description of Work: Ib -YY -e I I cd ri- o Jo.�.v i' -F '- 2 $ I ,--a, ^ 1 4--')--.
p c, --io r ►rc o1 • 0,-.A.5_,-. It; i 1 z rtr en i'—}
State:
PL zip: 3 3 I I
Specify color of color thru tile:
4111 tts'
Submittal Fee $ Permit Fee $
Scanning. Fee $ Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
C4
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 . a.. roved a d • reinspection fee will be charged.
Signature
OWNER or AGENT
Signature
CONTRACTOR
TF)e regoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
� �,,�daay�olf �Un n���0 c , 20 / ", by day of , 20 , by
1`� IC ��0 / ►'"50R -;`G, 5is pr��o _ y no n to , who is personally known to
me or who has produced a as me or who has produced as
identification and who did take an oath. �ONlldatiollpi/ identification and who did take an oath.
/
NOTARY PUBLIC: ,�\\\\ ;�g•••••s'B! . s>> NOTARY PUBLIC:
6,
o " '',
1.
`vs -,),;i la OS
Sign: _ • �n ' al
g= Sign:
Print: �y0� ti0� crt `* Pz: Print:
Seal: /4////Nlllll!!l1'*1e'.\!`" Seal:
APPROVED BY Plans Examiner
(Revised02/24/2014)
Zoning
Structural Review Clerk
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 dELECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
JOrB ADDRESS: G� (V0 OD Vo I
City: Miami Shores
Folio/Parcel#:
1r. 32-01e- 013 • Ski
Occupancy Type:
County:
Load: Construction Type:
RECEIVED
JUL 0 5 2017
FBC 20
Master Permit No. E L 11- 11 Z3
Sub Permit No.
O REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
is Da
Is the ;r• r g Historically Designated: Yes NO
Flood Zone: BFE: FFE:
DRAWINGS
Zip:
OWNER: Name (Fee Simple Titleholder): P 1 4. /V 1, i I J4jt�J 1 VS
Address: /3 `
`1 l� L
City: V V l t tM; � � State
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name: ,� /
Address: 1 41 2 ,SV V
. - e
illy L.4;•
City: Ilk State:
Qualifier Name: W,P 1 l la,
State Certification or Registration #:
Phone#: - D����
Zip: 3 71 Z i
Phone#:
Phone#:
1 gt, • 4,r1 - gSOc
zip:
pp D318
Phone#:�
Certificate of Competency #: a
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for
this2—‘59° Permit: $ ,59
Type of Work: l"l�isAddition ❑ Alter tion ❑ New
I
Descr' ion of Work: ' i RL ' innov i' um -. this' rAi:
4 ‘0 Lt, \- ti C.J' u c. -,C. \--to 5 _ e- d (' �d J
p z� 5001c- L (-o r% (-,1.-,/� j rMv 1 i 1-10-1-) .
Specify color of color thru tile:
Submittal Fee $ ✓ U Ford Permit Fee $ /FOD CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ 11 U' • 30
Square/Linear Footage of Work: 2 g(o v
Repair/Replace ❑ Demolition
(Revised02/24/2014)
Bonding Company's Name (if applicable)
1 i
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
fo' the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be ... roved and a reinspection fee will be charged.
4
',Signature
OWNER or AGENT
Signature �9—
CONTRACTOR
foregoingThe�f
instru ent was acknowledged before me this The foregoing instrument was acknowledged before me this
/
-A * day of VOL-- , 20 by day ofLt. , 20 { _ by
.1ctrui It
me or who h. ' .ed as
id take an oath.
me or wh. . s produced as
identifi ation . nd who did take an oath.
NOTA PURL C:
{
Sig
Print: Print:
Seal:
?91:-N LORETTA COMES
* MY COMMISSION # FF 954664
EXPIRES: March 21, 2020
tts
44.0,n Bonded Thru Budget Notary Services
Print:
Seal:
LORETTA COMES
MY COMMISSION # FF 954664
EXPIRES: March 21, 2020
4401,0, Bonded Thru Budget Notary 8ervlse$
*******************************************************************************************************
APPROVED BY )/D1,1 f'J-212 i Plans Examiner
Structural Review
(Revised02/24/2014)
Zoning
Clerk