FW-18-302, RC-17-1901BUILDING
PERMIT APPLICATION
BUILDING
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS: 10S0Mom- (O
City: Miami Shores County:
Folio/Parcel#: i
- ?23.2-o9B
Occupancy Type: Load:
OWNER: Name (Fee Simple Titleholder):
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
JUL 2 0 '018
FBC2011
Sub Permit No. 'fi VJ — . - 18 ' 3QZ 1 ( 11-1 01
❑ ELECTRIC ❑ ROOFING (REVISION ❑ EXTENSION
oSZo.
Master Permit No.
Miami Dade
D CANCELLATION
Zip:
Is the Building Historically Designated: Yes
Construction Type: Flood Zone:
Cipe,Ket. Kostwnsa.r,
Address: P O P 1.c.
City: L I iL L St-t
State:
❑ RENEWAL
❑ SHOP
DRAWINGS
NO
BFE: FFE:
Phone#: (:: & 1 14e8n 31%
Zip: 3316i
Tenant/Lessee Name: Phone#:
Email:
Phone#: l9B6, ZJd2
CONTRACTOR: Company Name: -• e3 -E- .Y O •
Address: s;33Zs KW lE rN - 2AC- �r�
City: 'DtP(Z` State: 'T1s91-Ba1-1 • Zip: 3302
Qualifier Name: AC:1k-)SWO Rent Osj Phone#: 080 UrrA2(4.l •
State Certification or Registration #: CRie. tS23 ( 2 2. Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: �J City: State: �1cr�Zip:
Value of Work for this Permit: $ U• Square/Linear Footage of Work: �w
Type of Work: ❑ Addition ❑ Alteration ❑ Demolition
Description of Work:
W000
❑ New ❑ Repair/Replace
Prey i S i o tel -to t kre< LiOCLsilo-+) c5' -gyp per} totiao
Specify color of color thru tile:
Submittal Fee $ Permit Fee 0 C' b CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ . Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Bond $
TOTAL FEE NOW DUE $99 s CA
Structural Reviews $
(Revised02/24/2014)
I �
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
.4` I
*+ ' Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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
rt
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 theejob 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
.•
•
\`OWNS GENT
The foregoing instrument was acknowledged before me this
is. r '
• •/�' ' day of ' -J✓ , 20 / e , by
(pit /12 (?vsit �//u�c wrho` personally know
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
_G L
Prin-t7lir WrirkTerkifr &,.
Seal: •q E.
='
***********
APPROVED BY
(Revised02/24/2014)
Notary Public - State of Florida
Commission # FF 191910
P;c My Comm. Expires Jan 21, 2019
Bonded through Natioral Notary Assn.
The foregoing instrument was acknowledged before me this
/2 day of J(Jh/ 20 /6 , by
.'US77ti/:it-* /9-L t'�who is personally known
me or who ha`s produced
identification -and 'who did take an oath.
NOTARY PUBLIC:
Notary Public - State of Florida
Commission # FF 191910
uti . vc
My Comm. Expires an 21; 2019
,,,,,
Bonded through National Notary Assn. �•
*****************i*ii*?i*u•*tr *********..
as
Sig
' "'Print:
Seal:
Plans Examiner
Zoning
Structural Review Clerk
Certificate of Completion
Miami Shores Village
10050 N.E. 2nd Ave, Miami Shores, Florida 33138
Tel: 305-795-2204 Fax: 305-756-8972
Description: INTERIOR RENOVATION, NEW INTERIOR DISTRIBUTION, NEW BATHROOM, NEW KITCHEN.
1050 NE 107 ST
Miami Shores , FL 331617374
If the building is located in a special flood hazard area documentation of the as -built lowest floor
elevation or lowest horizontal structural member has been provided and is retained in the records of
Miami Shores Village.
This certificate issued pursuant to the requirements of the Florida Building Code certifying
that at the time of issuance this structure was in compliance wi h the various ordinances of the
jurisdiction regulating building construction or use.
Not Transferable
POST IN A CONSPICUOUS PLACE