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RC-7-2196Ka W hiss CNa I I0i,1101 W'18,T DA 40 01 hoslxj i der 4p tt Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 L UIL%ING RECEIVED Permit No. Rul - Z-1 it APPLICATION OCT 2 9 2007 Master Permit No. BY: Aan1n, I Permit Type (circle) • Building Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) &A C, \ a Phone # j o S—'1 5-4 ! (3 oZ 0 Owner's Address 5,3 N W Qt3 rl SV City1'1. S r S State L Zip 3 1,50 PERMIT FBC 2004 Tenant/Lessee Name Phone # Job Address (where the work is being done) 5 am c 0,S a 6 ®Yl! City Miami Shores Village County Miami -Dade Zip 331 SO FOLIO / PARCEL # Is Building Historically Designated YES_ Contractor's Company Name TBA Contractor's Address City Qualifier Name State Certificate or Registration No. NO WS Phone # Zip Phone # Certificate of Competency No. Architect/Engineer's Name (if applicable) ce6 U pv f (. Phone # CJD f Value of Work For this Permit $ 15. 000.00 Square / Linear Footage Of Work: Type of Work: Addition Alteration New Repair/Replace Demolition Describe Work: QP tic c• V k'jcj? s, s w*L'V QVC 14 c.1 en nK e vt dc a w- n PAff e 4f/b SAF D Submittal'Fee $ Permit Fee $ CCF $ CO/CC Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 0,/ Contractor The foregoing instrument was acknowledged before me this ©cA6bt' The foregoing instrument was acknowledged before me this_ day of_ a0, 20.Q3 by k r CMZ 4!5 r-k day of , 20 _, by who is personally known to me or who has produced who is personally known to me or who has produced L --As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: i 1 LY _ ,: _ Sign: N°' „^ v®1GIIIC111 Print: Print: ° - ' '1444r My Commission Expires: ,-f 4 , ,, :rc AUG. C3, 2005 My Commission Expires: sed Tian A la.,ac Bt.ic..i.; Co., Inc APPLICATION APPROVED BY: Revised 02/08/06) Plans Examiner Engineer Zoning Miami Shores Village RLQ,—, °_—D Building Department AUGz 1019 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 4t INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 i- 0 BUILDING Master Permit No. C - 16 PERMIT APPLICATION Sub Permit No. BUILDING ELECTRIC ROOFING REVISION EXTENSION RENEWAL PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF XCANCELLATION [:]SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 5-2) MCA-- !Q7— City: QCity: Miami Shores County: Miami Dade Zip: 3 « Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): /LI rrF{fK—i, 5:4A4 C!#Ar*1474 Phone#: 3&5'- 710- 2( 7 [ Address: S3 hlL.cJ G.3'2y r--7- City: Al 144e SNfr9)2 4f:—z' State: Zip: Tenant/Lessee Name: Email: , Cyx'l hone#: CONTRACTOR: Company Name: 4 Phone#: Address: City: State: Zip: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: 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: 0 A-,& C --t- /-C M 12 -- Specify T Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ Revised02/24/2014) Permit Fee $ Radon Fee $ Training/Education Fee $ CCF $ - F CO/CC $...1=—.;~. l DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 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 $1500, 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"MttUri 4L SignatureSignature OWNER or AGENT The foregoing instrument was acknowledged before me this day of 20 \ by w -F''. o ispersonallykno to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: APPROVED BY Revised02/24/2014) WM RIVERl1 MY commissim t FF 239612 EXPIRES: June 23, 2018 Bmdsd Thor Nobly Pu* L*Av viten CONTRACTOR The foregoing instrument was acknowledged before me this day of as me or who has produced 20 by who is personally known to identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: as Plans Examiner Structural Review Zoning Clerk Is 1 Us'Yl, Share.5' ViI Q.e, Miami- 5Au s; R 33i3s Agri\ qid-o19 0 h4m Tk may ccylur n a cahc \1 a G - - MA r J tti G,t -- s S h a A- L t, `r l toe QrdCe5s