REV-16-632BUILDING
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
MAR 10 2016
FBC 20
Master Permit Nwec /1
Sub Permit No."I/)6 Z32.
BUILDING
❑ ELECTRIC
❑ ROOFING
® REVISION ❑ EXTENSION
❑RENEWAL
❑ PLUMBING
EAMECHANICAL
❑ PUBLIC WORKS
CHANGE OF
CAN ATION
[]SHOP
pac.}A1t-VG
DRAWINGS
JOB ADDRESS:
E FbA
NO C ON CO 0 0
City:
Miami Shores
County'
Miami Dade Zip:
Folio/Parcel#:
�� ,.
Is the Building Historically Designated: Yes _ e NO
Occupancy Type:
Load:
Construction Type:
Flood Zone: BFE:
FFE:
OWNER: Name (FeeSimpleTitleholder): � 5� Phone#: I 1 7-6 ' 7 0_7/'�,
Address: S 0 /U CD S
City:M`—IS State:
Tenant/Lessee Name: /_�14 Phone#:
Email: -p �+�,, L�
�f
CONTRACTOR: Company Name: W�' Abe;d Lb � �VLQQF IDN Phone#: 7 g6 1.2►( -� /
Address: -[ {�l�L> ,._CSbN- i K�) q� &_50(-) T% % Gl Q,G4I�'9t?f�
City: ��1�-Al�1 1h� '1 State: Zip: 3 3 d 7 3
Qualifier Name: _�� ��� �b� Phone#:7 V6
State Certification or Registration #:C6G / 5-1 3 Co Certificate of Competency #:
DESIGNER: Architect/Engineer: C7'CtrU L C1 r I ,�&Phone#: 771- l0`V
Address: +� City: State: Zip:
�7
Value of Work for this Permit: $ rpq�� Square/Linear Footage of Work: !% 0 g F
Type of Work: ❑ Addition "N Alteration ❑ New ,� Repair/Replace ❑ Demolition
Description of Work: T * c ( tJ 1c� U_ Z' (� D ( �
A, yJ CVO1 Vz ts'U 5.7 i wx, Q_C_)o A =Z-- k"7&
�R2C 0Q(-1 rZ(2 l l� uy 11-49 o W Off k_"i TWO N l t:�') C,C \5U v w >D L-L—
Specify color of color thru tile:'__7h,`_5 is 7!?c-- & 04-a4
Submittal Fee $
2 Permit Fee $ S - M
Scanning Fee $ J W Radon Fee $
Technology Fee $
Structural Reviews $
Training/Education Fee $
CCF $
DBPR $
CO/CC $ -
Notary $
Double Fee $ _
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ 7v 'Q
Bonding Company's Name (if applicable) Mtn
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Zip
State Zi
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. 1 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.
Signatu
WNER or AGENT
The foregoing instrument was acknowledged before me this
2-A day of M t L1 I n&+� , 20 1 4 , by
t 1�fN A4-eIISR, A496S5 , who is personally known to
me or who has produced4�'D&A1 as
identification and who did take an oath.
NOTARY PUBLIC:
Print: / L' .
Seal: �" '�a�;-, IVONNE LANDERO
Notary Public - State of Florida
M y Comm. Expires Jun 26, 2016
Commission # EE 211416
APPROVED BY
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
re
Or ` day of /uPrC k , 20 ( le , by
2U�h U gc/A-c, S who is personally known to
me or who has produced ) V -�/ �S L i C�1Si^ as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: Marco A. Caso
Nutmy Public
Print: -_ 0 State of Florida
p r y UOmmission Expires 08/18/201 L.
Seal: �'' % ������ ° Commission No. FF152135
Bonded through CNA Surety
Plans Examiner Zoning
(Revised02/24/2014)
Structural Review Clerk
ob
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CHANGE OF / ARCHITECT
Permit N. .
Owner's Name (Fee Simple Title Holder): A be.95 1�5 iydo,- P Phone #: q/ %-6 5 %- 0-7/3
Owner's Address: Ey'd Crrettr,d C6 hCOItrc t0
City: V) i O M i s h o r e, State: %l o r 4' d C Zip Code: 3/
Job Address (Of where work is being done): S qg Cr'rand & n coot r S
City: Miami Shores State: —Florida Zip Code: '331 3Y
rchi e4f-'.s
MRCEOI Name:
Address:
City: Iq
Qualifier's Name:
engineer of Record Name: Prto
Address: (q-3 5� 11'ra Ana r /act rkW R 1
City: M e r 0, M Q r State:
Re des,g n d'F e)( rJ& i+/G Sys+eM
Describe Work: �from F-,qSt 61d•e P` (?,�
d4
. Phone #: q5 y- 971- /U / 41
;Yre r o Phone
U) I+-kI H
Zip Code:
�'n�'hci• R
I hereby certify that the work has been abandoned and/or the ciont
is unable or unwilling to complete the contract. I hold the Building
Signature
Miami Shores harmless of all legal involvem
Signature
a- S-fe r y
hitect
cial and the
Owner or Agent Contractor ocArihitect
The foregoing instrument was aknowledged before me The foregoing instrument was aknowledged befo me
this; day of CU rG 20 ��by 16S � ��jp his 91 day of %�C rc k 20/6by,3+e �P N , 4'j40t)
Who is personally known to me or who has produced who is personally known to me r who has produced
F o013 307 4 3 d as indentification. as indentification.
Notary P 'c: Notary Public:
Sign: Sign: .
Seal: 4.-�o3'Y•?�a; Roslyn 0. Citrin
'COMMISSION#EE829921 Seal: 0. Citrin
EXPIRES: AUG. 23,2016 '?� -.". COMMISSION#EE829921
%•,,,,; ,F;o° WWW,AARONNOTARY.com EXPI RES: AUG. 23, 2016
�nnna% WWW.AARONNOTARY.Com
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S��veh L . C.�G►�� 4 A-ss�c1afer
S(2 mpIle l�Doj
ro
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1. Article'Addressed to:
1w E) rio A. Hewero,�E
bb 5M Ca,,5 Uttln , LLG
1y35Q fhiraw'a7l4rkmA
* 30L7
A. Signature
�,❑ Agent
E] Addressee
B. Rece4ed-by (PrinttedNoe'me) C. Date of Dery
2., zi& /U t `;, T
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(Transfer from service Iabeo
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