REV-19-494Miami Shores Village RECEIVED
Building Department MAR 0(V'2O19
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 201�
BUILDING Master Permit NO.OL (q -uG f
PERMIT APPLICATION Sub Permit No. {� \0'Qq
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 13 I (\J6 b 3 S YP fi
City: Miami Shores County: Miami Dade Zip: 3 (.3
Folio/Parcel#: 1 \ 3 20S o 3 0 O ( -.-)-U Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): SLAL t� PdC C( i N-Q-rer" an Phone#:
Address: E 3 a j sic 103 rd Street'
City: i'1( l yyl� Sh U' -es State: 1:7 zip: 3 31 3
Tenant/Lessee Name: iJ f Phone#: N 1-f
Email: f- CL-S (� V��/1"►tii' n r6o q rn CL:j- C.&—r-r►
CONTRACTOR: Company Name: U&en )'U n Pr Phone#:
Address:
City:
Qualifier Name:
e: Zip:
Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: GC-(-W �Q-{Vtr , D42&c'�S LLC� Phone#: � � `I � 2q � ' �-S�� 0
Address:-u �3 NW (y(0 F1 4e City:�i hit- State: Fi— zip: 3331 q
Value of Work for this Permit: $
Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $
Notary $
Double Fee
Bond $
C;T OD
TOTAL FEE NOW DUE $ C�i
(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 Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
n — day of `�—� QYLn 20 , by
I, t�rlio is personally known to
me or who has produced I l C Q as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of
me or who has produced
20 by
, who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
as
\ �� ry4 MY COMMISSION # GG OM602
Seal: ` Seal:
EXPIRES: November 2
wi+ P ` IwM liYu Notyy Pu ft
APPROVED BY Lf Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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
PERMIT APPLICATION
BUILDING ❑ ELECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS
JOB ADDRESS:
6, I O-3 r64 G-h
FBC 20 l�
Master Permit No. P,C' 1 —1 9 — ((,;,I�
Sub Permit No(Pij �r 2_�cc Tq
REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: u 3a-0S0 300 1 a-0 Is the Building Historically Designated: Yes NO 4�
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Phone#300 3 0ED
Address: 13 —4, OC 103 s-t�e�fi
City: !ti( 0-im ( S+-o`reS State: Zipg
s: r� 13
Tenant/Lessee, Name: N a -,Phone#: r "
Email: ajv-i 0_5 1042 /yD Oi Y!ld C b-Y
CONTRACTOR: Company Name: i'�1d r l (�� I ��✓r� C,�m Phone#:
Address: ` _;�a I M4 103
City:1I& 1)21 1 S. d re State:
Qualifier Name: Phone#:
Zip
1.3
State Certification or Registration #: �p 1 Certificate of Competency #:
DESIGNER:: Architect/Engineer: �i� &1G�CNVe Scams L LCPhone#:
Address: `I 3 1 " W Wj' Ay� City: LAIL&Ae'—" State:FL- zip: 33 31
Value of Work for this Permit: $
Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
Submittal Fee $ 7. Permit Fee $
�
Scanning Fee $ -I • � Radon Fee $
Technology Fee $,
(V - CJL� CCF $ CO/CC $ J
Training/Education Fee $
DBPR $ Notary $
Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ O;z:>
(Revised02/24/201 _ o - 'nA .+[�� V
Bonding Company's Name (if applicable)
Bonding Company's Address
City
a 1 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.
1
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
day of `t-\�v(� M 20�n 1 by
who is personally known to
me or who has produced�L^Nia5,
identification and who did take an oath.
NOTAR PUBLIC:
Sig I�
Print:
The foregoing instrument was acknowledged before me this
day of
me or who has produced
20 by
who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
as
Seal: Y�` " Seal:
00 P& Notary Public State of Florida
?° Sindia Alvarez
My Commission FF6156750
**�Kdii6P�kPgig �Ii2**
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)