REV-20-620: Q � YV'ED
BUILD
PERIVJ
❑ BUILD
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795 04 Fax: (305) 756-8972
INSPECT N- fNE P QNE NUMBER: (305) 762-4949
` FBC 201l-?
!FW —AL - [ a -�o-U
Master Permit No. ��', 11
Sub Permit No. VQ l�'�?
-M " 'zz
❑ ROOFING :�j REVISION ❑ EXTENSION ORENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: WA
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: n ^Constrructionn Type: �y Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): KMt� & 6�s D -' ,J � Phone#:
Address: o A NW � D(A
r
City: T"Am
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name:
Address:
City
Qualifier Name:
State Certification or Registration #:
State:
State:
Phone#:
hone#:
Phone#:
Certificate of Competency #: _
p: ►.S0
a
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
S �
Value of Work for this Permit: $ Square/Linear Footage of Work: �/4
Type of Work: ❑ Addition ® Alteration ❑ New ❑ Repair
/
Rep
la
ce ❑ Demolition,
Description of Work:
(lam �i ►. �� � n� (F - �U ,��--�-c ' ..
Specify color of co or thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ I co
(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 approv4o and a reirypection fee will be charged.
Signatu
or AGENT
The foregoing instrument was acknowledged before me this
day of 20 i� by
F7. C.Pis personally known to
me or who has produced `C___Zy�--K� as
identification and who did take an oath.
NOT
Sign
Pri n,
Seal
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20, by
who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
as
'� r � � Zoning
APPROVED BY Plans Examine g
Structural Review Clerk
(Revised02/24/2014)
i �ess`=t 3 (Sketch of Survey) - See Sheet 3 f 3 - r hC r�� Vi f � ta. SIJRV9 IS NOT COMPLETE WITHOUT ALL SHEETS d
1 RV COTE
NON ..'A_..._— r
� I /
- . �d7�rf�
$ ..i I
SCALER "=30'
t Lill— ME
17 r r�1 [� AERIAL PHOTOGRAPH
.�(�fAYN,OTsHO'v+�rEsril,!PRoI�E�lEr;rs;: '
w
F`•a,.. .� - - f — f
FOUND • i
... I IRON I •
• 0.97 WEST ,_ _ . .. •
5WALK J
55.3-51.a FOUND 1/2', ^ =
.ram IRON PIPK , be - r
i CONCRETE
WALKWAY
—
1 + •
s
'a C,kf
' 9.23' —V
b (�'
ONE STORY o
WELL o RE51DENCE #54
m aNt ■ —s i
CONCRETE N LOT12
• • • • do BLOCK 124
• • { DRIVEWAY �
• • •••• 23.50 bN 4.00' I
•••••• t N 31.50 ICE $ 5.99,
• • � • • � � 'FENCE ' �o
•••••• • •• @ONUNEto N 11.10
• • • • c Z
o
Go. o
•i•••• •• •• •• •• CONCRETE Q �� G n
o
• • • c • o
• LOT 14 DRIVEWAY LOT 13 v� �` S r 0 Q r L L
••••• • • .•••••• BLOCK124 N
BLOCK 124 �/ r E-
• •so so •
• • • .� t1E
• • • • ••
• • • •
•••••• •••• • • FENCE
• • • • FENCE K`M FENCE 3.8' IN FOUND 3!4"
30.00 0. I' IN IRON PIPE A/�
FOUND 314'—
RON PIPE ! 9' ROADWAY f Gj,�G'jl_$i:Jj 15' PLA
Platted Easements Notable or A verse Conditions u Ola±':d- ' -"�E�I�P
(nP qq i y13�UR-GEY OUID RENEW E PO F NY �,
'LINES SHOWN HEREON AND THEIR RELATIONSHIP TO THEE( MAR 2 3 BOZO
NONE FOUND ► ' E
t
BY:
I
This survey has been issued by the f hva g Landtec Surveying or�t) 600 Fairway Drive - Ste.10119- f:>
Deerfield Beach, FL. 33441 ANunber: 9s473.sE Rev.
Office: (561) 367-3587 Fax: (561) 465-3145 'Dra �: j.- Rev_ S U R V E Y I N G
y
rr: ;;.� y F ,•i:,ci f' •r,i..t t. Ivy. M 1 t .:a.. i ..': x:.
www.LandtecSurve com ._..._
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