PL-17-983Miami Shores Village RECEIVED
ii
Building Department APR 072017
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 20
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No:(2
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION RENEWAL
[PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: Is
0
Folio/Parcel#: i 1-M�VUB "1 (to Is the Building Historically Designated: Yes i NO
Occupancy Typey Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):(S V � rY-�,IW160 l Phone#: no �3Z�
Address: �ri 1 0-2- S 9i
Tenant Lessee Name:
Email
State:
• • • •. Vr , 1 11�•�:i FA . l
..wlog Rx1�'3�3
Address:
City: M U
Qualifier Name:
Zip: S)1 _�S one# WW A iq- k Vat)
State Certification or Registration #: C. w S I q'I " I 1 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: �City: State: Zi
Value of Work for this Permit: $ Square/Linear Foota a of Work: sn
Type of Work: ❑ Addition ❑ Alteration ❑ New epa' /Replace ❑� Demolition
Description of Work:
_n nf,w S w wnrn nP bl1(
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
c�
Permit Fee $ .22J� CCF $ CO/CC $
Radon Fee $
Training/Education Fee $
DBPR $
a
Notary $ it
r
Double Fee $
Bond $
d
TOTAL FEE NOW DUE $ 119
(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
Zip
City State 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..... s
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be p roved and a . spection fee will be charged.
Signatu Signatur
OWNER orA T CONTRACTOR
The foregoing instrument was \ acknowledged before me this
�� ,A day of PI � 1 20 Ja by
j�-i � 1CCi �� , who is personally known to
me ho has producedh-1 )®Z l ku IIAIV
c)entificatio and who did take an oath.
OTARY PUBLIC:
v 1
Sign:
Print:
Seal: ,►ay P&
W : •'• ,�� NATHALIE BASS
My COMMISSION t FF 166797
EXPIRES: Octobe 7
The foregoing instrument was acknowledged before me this
Aday of 20� by
vti1 kA ( A �VZ who is personally known to
4oras producedM5Zt)1,44-7e- 4?, -s
and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal: �?`""¢ NATHALIEBAS3
* * MY COMMISSION ii FF 166797
EXPIRES: October 7, 2018
2018F,de Bonded Thru Budget Notary Serik"
s��e���e*ssus**'���sGisr�hP4�ekMc���*s**s:*sssssssss*ssss*ss*��s*s*�s�sssssss*sss�c�ss*�**sssssr:ss***rssss
APPROVED BY y�Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC ❑ ROOFING
RECEIVED
AP 0 7 1017
CI �
F C 2oM
Master Permit No. Popp I-:�'Ci S 2
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 5 7:� n -C., I osZ ;�>-A
City: Miami Shores County: Miami Dade Zip: 13$
Folio/Parcel#: I I -- 32(Oy --) t DC-C> Is the Building Historically Designated: Yes NO
Occupancy Type:+k7l(?-Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 17�5'fC r 1=C�( I Phone#:
Address: S� rrt-- 1S 1
City: M 1a r-r) Skc:>y-tS' State: L Zip.-
Tenant/Lessee Name:
Email:
ne#:
CONTRACTOR: Company Name: l , S4" ��i�1C�,p1 ��J('�� �rV 1C-ei Phone#:
Address: 1:1II SA-) '->
City: M 1`O n'1 1 State: "(—L Zip:
Qualifier Name: Lr-c�-j Phone#: —I w --A I n — 12. po
State Certification or Registration #: C CjCs I�Ig4-Aq Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address
hone#:
Zip:
Value of Work for this Permit: $ 1 Ci I a-00 • (--X.::> LI Square/Linear Footage of Work: Av
Type of Work: ❑ Addition ❑ Alteration ❑ New pair eplace ❑ Demolition
Description of Work:
1 t'11 S
Specify color of color thru tile:,
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
(Revised02/24/2014)
Permit Fee $ � 7
Radon Fee $
Training/Education Fee $
City: State
CCF $
DBPR $
Jt
CO/CC $
Notary $
Double Fee $
Bond, $
TOTAL FEE NOW DUE $ s - I
Bondiriif Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
City 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. 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 a oved and a reinspection fee will be charged.
X
SignatureX Signature% '
OWNER or A N CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 l by day of 20 J� , by
who is personally known to 0 Pu who is personally known to
FcatpiUon
has produced �'k� Cao NZ —�me or has produced �Z® OT4a� D
and who did take an oath. i tifi on and who did take an oath.
NBLIC: NO ARY PUBLIC:
rv\nSign:
L/1V "'.
Sign:
Print:
CC
. J
Print:
Seal:
••••.
MY COMMISSION # FF 166797
* EXPIRES: October 7, 2018
Seal:
A Ay Pp
°�.
+° ; •'••,
* *
NATiiIWE BASS
MY COMMISSION # FF 166797
%"40F"04� Bonded Thru Budget Notary Senices
�r��'OF
EXPIRES:
P\OF
WiySerke
Bonded ThN Budget Notary Services
APPROVED BY
Plans Examiner
Zoning
Structural Review
(Revised02/24/2014)
Clerk
Miami Shores Village
Building Department OCT s 2017
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
ABUILDING
PERMIT APPLICATION
❑ ELECTRIC ❑ ROOFING
❑PLUMBING ❑MECHANICAL ❑PUBLICWORKS
JOB ADDRESS: 5—j 3
FBC 200
Master Permit No. t)P? \1 9 6-2-
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
HANGE OF ❑ CANCELLATION ❑ SHOP
l ONTRACTOR DRAWINGS
3)
Folio/Parcel#: it -` ao-() v3r- 1 000 Is the Building Historically Designated: Yes NO_
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):_,) e;VC � Phone#:(�a� 32 6- 41(p�j
Address:
City: ' M `►airyV (� rr.S State: Zip: 3 3):3
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Na��m``e:
Address: 1523A Iyy
City: M 1 G 999
Qualifier Name:
State Certification or Registrati&
DESIGNER: Architect/Engineer: _
Address:
Value of Work for this Permit: $
Type of Work: ❑ Addition
Description of Work:
419
EL- Zip: 3 301 LI
Phone#: ;{n, y l q- k 26 (�
#Uf-I C 1 J\ C1 LA 3A Certificate of Competency #:
1 c) eco 0o
9 Alteration
,1n
Phone#:
City: State:Zip:
c-4 Square/Linear Footage of Work: y a
❑ New ❑ Repair/Replace ❑ Demolition
Wt p�
'lr�c . -A )_ tom 1f1��1rn�A
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $
Structural Reviews $
Training/Education Fee $
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 Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of{_n �/A�'rU'�i� 20 i� by ? l ' day of �( � 20 la: by
who is personally known to who is personally known to
me or who has produceQ ATW3-JJX;A7Z"Q) as me or w has produced as
identification and who did take an oath. identification and who didtake an oath.
NOTARY PUBLIC:
NOTARY PUBLIC:
Sign: (�(�/� ' o� ( Sign:
Print:—���Y►1 1t•1t�----=�, r Print:
Seal: ��"r •u,� NATNAI IE BASS Seal: �r"r �osi.� NATHAUE BASS
� ' � *
* S68797 * MY COMMISSION # FF 188197
EXPIRES: October 7, 2018 * EXPIRES: October 7, 2018
MY COMMISSION #
°•, aP� Bonded Thru Budget Note Services ui Bonded ThN Budget Notary Servkes
.Ear... OF Fvo
r******s*s**********s*sss*srs* �********s************srss**ss�s*s**ss*rs*********•**************rss****r**r
APPROVED BY Plans Examiner Zoning
J .
Structural Review Clerk
(Revised02/24/2014)