RC-17-1842Rc I I., (sqz
p.L fu L.a�c�
� t
1
Miami Shores Village RF_k' °
Building Department JAN082019
.1`
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
v Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 ce
FBC 201-4
BUILDING Master Permit No. RC --4 -.4-+ •- 4 �4Z
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION [:]SHOP
CONTRACTOR
DRAWINGS
JOB ADDRESS: 63 N o X) A Oa
S+val'
City: Miami Shores
County:
Miami Dade
Zip:
11
✓1 (�
Folio/Parcel#:
Is the Building Historically Designated: Yes
NO
Occupancy Type: Load:
Type:
Flood Zone:
BFE:
FFE:
OWNER: Name (Fee Simple Titleholder):
,Construction
14- A/Z!Q F. NAIZlVt
/
(,'9S �t1c�
c� -7 G
Phone#: �64 _ 396_ d 7 T C
Address: (n 2 /J, W i o � S�ieA
City: S%A at \)102a-5
State: rz
Zip:
3.3 O
Tenant/Lessee Name:
Phone#:
Email:
CONTRACTOR: Company Name: Phone#:
Address:
City:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Ad
Value of Work for this Permit: $
Type of Work: ❑ Addition
Description of Work:
Zip:
Phone#:
Certificate of Competency #: _
Phone#:
City: State: Zip:
Square/Linear Footage of Work:
❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
-ram_ (0"" 9-C ►---i -1 P�22
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $_
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
Signature
CONTRACTOR
The foregoing instrument was acknowledged before q this The foregoing instrument was acknowledged before me this
day of 0 n by day of 120by
icqh is erSAnallvi! no ;n o who is personally known to
me or who has produced ;i'1 _ 1 fuels me or who has produced as
identification and who did take an oath.
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
******�*************************■*********s********ss�***s*.*********s*sr************r**s****:**:*********
APPROVED BY �� f / Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
JkC)2Z
1VP aF G �-
�16D So f'�J � •� "� �j�eh� 2
sV v
6�/V�-
Niff ui S/lo/Lc S, F4- 3 .? ,/S o
�lANJ, ��/Uu11R r
o
ren- kzl 14
.&��e.
T4e aso h cao ci?ll
(u6h'4 —10 00021, .
(' -T o 4 z h j �' cs h h o�- z m die Got a-
GAT T�;. M,�Dj 1K IA/,,9 J` f1 O 7L
ti
BUILDING
PERMIT APPLICATION
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 ❑ ELECTRIC ❑ ROOFING
FBC 20 N
5
Master Permit No. ice= F4— I PA 2—
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
Folio/Parcel#: d .A Z A .9 Cp "I 3 - A OD Is the Building Historically Designated: Yes NO
Occupancy Type: Load
OWNER: Name (Fee Simple Titleholder):
Construction Type: Flood Zone:
BFE: FFE:
- 9G6- -t3
City:'Ni, Nl SuOp-la.S State: P L Zip: 3 A 5
Tenant/Lessee Name: _ JA Phone#:
Email: 2 L. . Cc> Yy _
CONTRACTOR: Company Name: .� �\�J� aNM�2 Phone#:
Address:
r1a
W
City: �CCfw- k State: zip: 33 (�CZ �f
Qualifier Name: �\ \ (' - C�C`�'�"��—rJ'��':J. Phone#: -)-&b .333 SZ q&
State Certification or Registration #: Cg IN I G -iS�i Certificate of Competency #:
DESIGNER: Architect/Engineer: . c 15T0 Gc�� C7_ Phone#: 3o s, � �'l 1)
Address: I k 2 SW R k S1 City: , State: Zip: _37' 1
Value of Work for this Permit: $ S - o nc) z Square/Linear Footage of Work: l Z 13
Type of Work: ❑ Addition ❑ Alteration ❑ New ITS( Repair/Replace ❑ Demolition
Description of Work: V := ,-;, UNCIF C> \ \ PCA, .4-
Specify color of color thru tile:
Submittal Fee $ gJ, W Permit Fee $ 2-�O • 0O CCF $ ' 4 C) CO/CC $
Scanning Fee $ Radon Fee $ 2' "t0 DBPR $ "j • 105 Notary $ t. • 43
Technology Fee Training/Education Fee $ (' QJ.0 Double Fee $
Structural Reviews $1Z • OO IZO CZ Bond $
TOTAL FEE NOW DUE $ I
(Revised02/24/2014)
onding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 commencemenlryit be posted at the job site
for the first inspection which occurs seven (7) days after the building pe7111
In the abs osted notice, the
inspection will not be app ved and a reinspection fee will be charged.
La
r nn I
NER or AGENT
The foregoing instrument was acknowledged before me this
day of U 1 20 . by
I S 1'G r�
i it r �1vho is personally known t3
me or who has produced US MS�100\0— as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
MHHARAI K. GONZAL —
MYcnnn►AIL- , .... _
>;"{;4P' Bnded : November 2020
Seal o
7hruNotaryClicUnderwriters
Sign
The foregoing mstru ent was ack
day of
me or who has produced
befo me this
20 by
0o--RdAy known to
as
identification and who did take an o,
r
NOTARY PUBLIC:
to=`Y PieFlorida
Notary public State of Florido
} ? Sindia Alvarez
1• c� My Commission FF 156750
Expires 09/03/2018
Sign: r, A .+ A. 4 �.. -,A
Vint: N�) 02s, f\ L4eT"4
:rs*•s*r**sss**.*****+es*******■*s*+e sss**•rr r**s*ssssss***srss*sss**•s*rs*****�r*••*ssrsss*«.•s*�esss**s•ssss
6 /
APPROVED BY Plans Examiner G Zoning
Structural Review
(Revised02/24/2014)
Clerk