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Miami Shores Village RECEIVED
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
305 756-8972
UMBER: (3', ) 762-4949
BUILDING
PERMIT APPLICATION
, BUILDING ❑ ELECTRIC ❑ ROOFING
JUN 0 5 101VA
FBC 2Oi 1G
aster Permit No. I �CCW —5 — l %" 14f
Sub Permit Noi1-U — 1S2—S
0: REVISION ❑ EXTENSION ❑ RENEWAL
v -
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: c7S 3 ►4 E C 4 �+
City: Miami Shores
Folio/Parcel#: 113'20(4O 13'&'2-0
Occupancy Type: Load:
County:
teh
Miami Dade Zip: 32
Is the Building Historically Designated: Yes NO
Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder):Til5hXy i�G1 Per -ea
Address: 1`�" l
city: A cLKAI 31- z as
BFE: FFE:
Phone#: WS. . Ojc (p
State: PL_ Zip: 3313/3
Tenant/Lessee Name: Phone#:
Email: silky a ►('me_4Co 3rr c-om
CONTRACTOR: Company Name: b Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration #:
DESIGNER: Architect/Engineer: _ Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ I—
Type of Work: ❑ Addition ❑ Alteration
Description of Work:
-Ceiat t / Yuen
Q,r(l sQtf \�xk�rj Q�IeS .
Specify color of color thru tile: ' aF�. ,`,° ,\'•
❑ New
:Certificate'of Competency.#:
ry. \
Submittal Fee
Scanning Fee $
Technology Fee $
Structural Reviews $
Square/Linear Footage'of Work:
Repair/Replace ❑ Demolition
WI; 12
oil tiC r€ 0i-1' C lesl
' i 4
Permit Fee $ CCF $ CO/CC $
Radon Fee $ DBPR $ Notary $
Training/Education Fee $ Double Fee $
Bond $
TOTAL FEE NOW DUE $ H3-01/4-D
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
; �' t fir
Mortgage Lend}A
Lender's Address t
is
City . State
._...Zip— - ---
• •
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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.
, y1t
� e 4
OWNER or AGENT
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
S day of 7LJ..It. 20 1 Fr , by day of , 20 , by
5)4A`eh id QDili1ft. N4, ST0 4ficiga Ily nR'own , who is personally known to
me or who has produced Pc— Vf/L_ as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC:\\\����\\111111111*I//�i�//,/
�q�'�
�• •(:IQIRES ��• ,
•\off S. Yam_
Sign: _ : P R Ei w' Sign:
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Print: sd� st,• - . • = Print:
•- �o.;:' \
�� Seal:
Seal: //ii/j//I11 NO ikP0
NOTARY PUBLIC:
*********************************s*************************************s***********************************
APPROVED BY
Git%
Plans Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)
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axr?r DEPT
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RECEIVED.
JUNog'�i8
nage
DATE
;,'I CT TO COMPLIANCE WITH ALL FEDERAL
AtO COUNTY RULES AND REGULATIONS
sb.
FOUND 1/2°
IRON ROD
NQ I D
SURVEY NOTES
I HtHE ARE hENCES NEAR THE BOUNDARY
OF THE PROPERTY.
I HEREBY CERTIFY THAT THIS BOUNDARY SURVEY
IS A TRUE AND CORRECT REPRESENTATION OF A
SURVEY PREPARED UNDER MY DIRECTION.
NOT VALID WITHOUT AN AUTHENTICATED ELECTRONIC
SIGNATURE AND AUTHENTICATED ELECTRONIC SEAL,
OR A RAISED BABOSSED SEAL AND SIGNATURE.
.r Digitally signed
Kenneth
by Kenneth
/ 'Osborne
Osborneo'ke:2217.05-22
1838:05 -cuito•
FOUND 1/2"
IRON PIPE
NO I.D.
FOUND 1/2" `0
IRON PIF
NO I.D.
LB #7893
SERVING FLORIDA
6250 N. MILITARY TRAIL, SUITE 102
WEST PALM BEACH, FL 33407
PHONE (581) 640-4800
STATEWIDE PHONE (800) 228-4807
STATEWIDE FACSIMILE (800) 741-0576
WEBSITE: htlp://largetsinveyIng.net