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RC-13-2885Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 AIL%6TlLl clAL PERMIT APPLICATION Permit Type: BUILDING JOB ADDRESS: 78 NW 106 ST JAN 0 2 2014 FBC 20 Permit No. i�_/�� Master Permit No.gc, `, ROOFING City: Miami Shores County: Miami Dade Zip: 33150 Folio/Parcel#: 11-2136-005-0230 Is the Building Historically Designated: Yes NO X Zone: OWNER: Name (Fee Simple Titleholder): Alejandra Gutierrez and John Southerland Phone#: 305-799-0822 Address: 78 NW 106 ST City: Miami Shores State: FL Zip: 33150 Tenant/Lessee Name: Email: CONTRACTOR: Company Name: SUN '5 L"Phone#."baO S 6� q�/ Address: _�� od `a C'u k/ cz7r City:- /�'� 1` State: Qualifier Name:(` /-�� / %� s vJ/�/c� Phone#: State Certification or Registration � (Certificate of Competency #: Contact Phone#: mail Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ a Square/Linear Footage of Work: Type of Work: ❑Addition ,/ W-Afteration ❑New aepair/Replace ❑Demolition Description of Work: &P 6FI (� 'IJ 1444W Color thru tile: Submittal Fee $ 5-d • C)() Permit Fee $ /.S- L��dG CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ 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 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 he issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a c of th notice of commencement and construction lien law brochure will be delivered to the person whose property is sub' t to tt hment Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspect' n whi h ccur e en (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not a pr v a nspection fee will be charged. �j I,-- Signature Owner or Agent Contractor 3 The foregoing instrument was acknowledged before me this �`� The foregoing instrument was acknowledged before me thfiZ) ��l�IJ 50 JT�♦\ww7Z A.7� day of Du. , 2013 , by day of c� , 20 _U' , by t-R cam► Caves Sc,�S't v;b�s who �ispersonally known to me or who has produced who is onall known me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: �q4 Notary Public State o 'on,,,a My Commission Expires: ^ Barbara Rodriguez -Cardoso p� My Commission DD956326 '?on o" Expires 0112712014 identification and who did take an oath. NOTARY PUBLIC: Sign: f r11100m 11Qa"faimm My Comm es: EMRES: AL 05, 2015 tlon0�tt thwpn to Stets lawnna APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) r Miami Shores Village Building Department JAN 0 2 2014 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 FB C 20 p BUILDING Permit No. PI 13 20 Q PERMIT APPLICATION Master Permit No. &'1'3 Permit Type: 'A", k) JOB ADDRESS: 78 NW 106 ST ROOFING City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-2136-005-0230 33150 Is the Building Historically Designated: Yes NO X Flood Zone: OWNER: Name (Fee Simple Titleholder): Alejandra Gutierrez and John Southerland Phone#: 305-799-0822 Address: 78 NW 106 ST City: Miami Shores State: FL Zip: 33150 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name JSQO t G r1 EQJ D✓V` S 10L- Phone#: 7 el Address: ' ' 15 (- --",0 Q (07h A± -Q -7 - `t4 3 9 S R City: (41 cx'cs t State: Zip: 324 b Qualifier Name: A tVTJ i.1t 0 Cs. 0CLC-Q Phone#: State Certification or Registration #: C1=c- I'l Q �_ 99j Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ a ' U J Square/Linear Footage of Work: Type of Work: ❑Addition y� ❑I Alteration "� ❑New b4pair/Replace ❑Demolition / Description of Work: A� ,I ijk WINft Color thru tile: Submittal Fee $ Permit Fee $ d CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 4 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 co y e notice of commencement and construction lien la brochure will be delivered to the person whose property is sub' t to tt hme t. lso, a certified copy of the recorded notice of cgitmencement must be posted at the job site for the first inspec on w ch ccurs eve (7) days after the building permit is issued n the absence of such posted notice, the inspection will no e p ov and r spection fee will be charged. " Owner or Agent The foregoing instrument was acknowledged before me this fit~ day ofD&. �d , 2011 , by b, o►w S,J.+w t�.,�d ��t who is personally known to me or who has produced A. & As NOTARY PUBLIC: Sign: Print: My Commission and who did take an oath. :o"RY b'�e4^ Notary Public State of Florida Barbara Rodriguez -Cardoso a o` My Commission DD956326 Expires 01127/2014 Contractor The foregoing instrument was acknowledged before me this-5:Z�_ day o , 2V&, by A 1a-T o "ib who is ersonally �kno to me or who has produced as identification and who did take an oath. NOTARY P L.R. COM MY COMMISSION #EE10t " a amps- JUL 05, 2015 Sign: 9°ndedAl�V* 10t &w MWJM Print: i, d a C��J APPROVED BY Plans Examiner Structural Review My Commission Expires: Zoning Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)