REV-18-138BUILDING
PERMIT A
❑ BUILDING
Miami Shores Village
RECEIVED
Building Department JAN 18 2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 JT' (
INSPECTION LINE PHONE NUMBER: (305) 762-4949 Sh
6
• FBC 20i i.gio L(
Master Permit No. -Pv\J . 4 21 1 3
Sub Permit No.'.y (8" IS
N •❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL 70PUBLIC WORKS&E OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
�%c G .,l
JOB ADDRESS: % J i a iv %7i/ N7 A\I 2
City: Miami Shores County: Miami Dade Zip: r3 3 /cam ei
Folio/Parcel#: Is the Building Historically Designated: Yes ,NO -
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (F/GeeSimple Titleholder): / "/ /L
Address: 9./ t� /I/ J`%//)"`i /' f) v
Phone#: 305 36-5 / -1/9
City: /l on %/ $/' V fk s State: Tt Zip: 3 3 /56
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
f ,
State Certification or Registration #: s °Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address: City: State: Zip:
i Value of Work for this Permit: $ 6 69 .• 0 Square/Linear Footage of Work: l / 6
Phone#:
Type of Work: ❑ Addition ❑ Alteration ❑ New 2 Repair/Replace ❑ Demolition
Description of Work: 'Aft l S% e6f& Ji( -- /9DQ / A) o
•;II * tie• SrvC_x e. .r'WWM9nFY eFf•.W*49 r'aYs-wN.�' :rk
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Specify color of color thru tile:
...v.a .:.. a..,. .: n. +. J
•4.:Pc r' • .a
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 $
(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
t
commenced prior to the issuance of a permit and that all workiwill be performed,'to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate},permitlmust be secured for ELECTRIC, xPLUMBING, 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
NER or AGENT
The foregoing instrument was acknowledged before me this
�cT day of Cln , 20
Q
Q`1 ,w ors e1D1 yk n o
me or who has produced
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of , 20 , by
who is personally known to
pC(S 001*as me or who has produced • as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC:
APPROVED BY
MY COMMISSION # GO 044602
EXPIRES: November 2, 2020
',Fife 5g:t7- Bonded Thru Notary Public Undennriters
NOTARY PUBLIC:
Sign:
Print:
Seal:
/1 Plans Examiner
Structural Review
******** *********************
/i/C/ Zoning
Clerk
(Revised02/24/2014)
RECEIVED
JAN182018
TLAy . OF SU : T.;Y
for
II. E . RANXIN
I3tGINEE ' S CE.-tTIFICATE:
I hereby certify that -
Lot 4 and the North half of Lot 5
in Block 131, of "MIALI SHORES.
Section 6," according to the plat
thereof recorded in Plat Book 10,
rage 39, of the Publio Reoorde
of Dade County, Florida', have
been surveyed Vander my direction
and the building located ae ehown
hereon, November 28, 1938.
There were no encroaehmente.
WTI
deaietered Land Surveyor
Registered Fhgineer. 6o7
State of Flori-da.
. PERMIT #: .
Miami Shores Village
APPROVED
ZONING DEPT
BLDG DEPT
BY
• . .
%ALE' / 20
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ST
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se-ttSeti�
ATE
L 1
SUBJECT TO COMPLIANWITH AU- WALL DERA,-
_- A -b-Cel t i sR!„,iL S AEID_REGUtATIONS
N l-4- 2 I
W. T. F:FING
5150 N.6. 2und Ave.
?Miami, Florida.
2/6 /0.52