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Miami Shores Village RUD
Building Department10050 JAN
N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
BUILDING
Master Permit No. �j)4
PERMIT APPLICATION
Sub Permit No.
BUILDING
❑ ELECTRIC
ROOFING REVISION EXTENSION EJRENEWAL
F-IPLUMBING
❑ MECHANICAL
PUBLIC WORKS ❑ CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
01ItCl Ck--
City: Miami Shores
Co tv: Miami Dade Zip: 0
Folio/Parcel#: '
I ' 31 01--6I8
r 6270 Is the Building Historically Designated: Yes NO
Occupancy Type:
Load:
Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titlehold
Address: h `1 N (k-) r lu k
City: nA.& State: _
Tenant/Lessee Name:
Email:
hone#: -�96 --S2 t ^SU '� T
f ,t--
CONTRACTOR: Company Name: )f�/� y Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER Architec Engineer:_MA2►� A- GAiMPQO: i--LP4ZtA4-176t4- Phone#: 3dS %S q • 23 )$
Address: Al E 92 City: M/Am 15 It3" SState:V — Zip: 33 i 3 e
Value of Work for this Permit: $ 12,500o Square/Linear Footage of Work:
Type of Work: Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: W D maw FOR V- cn o CiyrTV-0 a 15- �K PAX-10I09
ICJ E—W MA-STS( ,6A M * MQ
Specify color
of ccolor/thhru tile: y Submittal Fee $vimy Permit Fee $
Scanning Fee $
Technology Fee $.
Structural Reviews $
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $
Notary $J ' As
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Company's Name (if applicable) _
Bonding Company's Address
City, - "�'t 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 buildin ;pis►'Fnith an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commegceihegt and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified,,,i opy-'of the recor01'
ice of commencement must be posted at the job site
for the first inspection which occurs seven (7) dayss,after�iie builder hgissued. In the absence of such posted notice, the
inspection will not be a pr ved and a reinspection fe.'e; ill be ch r,
�% �1 Sao
Sign
OWNER Or AGENT
The foregoing instrument was acknowledged before me this
- Lq day of 20 =:+ by
Mohi Cci P Crllwo;�`lepersonally
yknown to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of , 20, by
who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: ' 'T �.my COMMISSION # GG 044602 11 Print:
=;: MF' ° EXPIRES: Noyember2, 2020
Seal:=;;ao;;�op•' Bonded Thru Notwy Public Underwnters I Seal:
APPROVED BY
Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)
Miami Shores Village
FECEIVLD
BUILDING
PERMIT APPLICATION
Building Department APR 02 2019
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 V 1
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 201--
Master Permit No.T�C' - I � - 6 `I
❑BUILDING ❑ ELECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL ❑PUBLICWORKS
Sub Permit No.
❑ REVISION ❑ EXTENSION [:]RENEWAL
❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: ti
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction. Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Qra7Co a so- Phone#: 7�— Ar
Address: !zk&L I rVI A S�
City: S",re\ State: Zip: 3
Tenant/Lessee Name:
Email: �01 SV i2 ^ Conn
o' x
CONTRACTOR: Company Name:
Address:
City:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
hone#:
Phone#:
Zip:
Phone#:
Certificate of Competency #:
one#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑/ Alteration ❑ New ❑/Repair/Replace ❑ Demolition
Description of Work: do C � �l 11 A k&,r, 4- IV 3
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $.
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF S
CO/CC $
DBPR $ Notary
Double Fee $
Bond $
TOTAL FEE NOW DUE $ _
(Rev1sed02/24/2014)
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.
Cs -
Signature �--'
R o1Q1` r AGENT
The foregoing instrument was acknowledged before me this
2 day of r 20 by
who is personally known to
me or who has produced 5 "P-- as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
MAHARAI K. GONZALEZ
c'
MY COMMIS
Print:EXPIRES:
November 2,2020
:;FOF Flo?
Bonded Thru No�ary Pub is n e
Seal:
Signature,
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of , 20 by
, who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
as
s*************s*s*****�**:****�*****':-**:`s**s********s**sss****s***:***•***************rr*rr**sr*********s*
APPROVED BY ' r Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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