PL-17-2404BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
Miami Shores Village
,F-
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
FBC 20 `A
Master Permit No. I-1
C fl pi r m i rn Sub Permit No. rLA1 -'-�N CN
❑ ROOFING ❑ REVISION
❑ EXTENSION [:]RENEWAL
NPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: —is the Building Historically Designated: Yes NO
Occupancy Type � Load: Construction Type: / il-' Flood Zone: BFE: FIFE:
OWNER: Name (F a Simple Titleholder): a b W'f "l ��fif � ) "' t Phone#:
Address: X,i� �� 1 W W 0
N' f►- `AA �
City: X 1V 1'�y_`�_�1M� State:
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name: `-
Address: - ;'G/ "41' )('� , " �3
City: `� r �` /�2 s
Qualifier Name:
State Certification or Registration #:
1-17
r'\
p: 3�1G0
ne#:
ne#: --Ic s
z— Zip:
Phone#:
p / Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#: _
Address: City: State:
Value of Work for this Permit: $ %oc 0 h Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ AI eration ®, New ❑ Repair/Replace
Description of Work:
Specify color of color thru tile:
Zip:
❑ Demolition
Submittal Fee $ Permit Fee $ .2 :2j CCF $ CO/CC $
Scanning Fee $ Radon Fee $ Z ° DBPR $ � Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Company's Name (if applicable)
i 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 s h posted notice, the
inspection will not a roved and a reinspection fee will be charged.
ature _ Sig ure
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
l-? day of 20 / —7 , by
,who is personally known to
e or who has produce 1 �: as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
The foregoing instru n as acknowledged before me this
day of 20 / by
r W-4011f► who is personally know2to
_me or who has pro uced 'A 4 as
identification and ho. . <e n E A
NOTARY PUBLIC: WIRESMay4,2DIR
(407)39 133 F7asitlaN�BKvitooam
Sign:
Print: Oar F SEAtJ
t (. ,SION *01 i*AA5
Seal: / .mow♦ F.N "_,' Ma , "'Jig
(407)3ltFOlss Ft,. li �'i '':f.:.�ll
JORM RMEAU
*** �**� EE/
APPRO EVVY398-0153 �?D�' i'""''s`''"`"d0"` la miner Zoning
Structural Review
Clerk
(Revised 02/24/2014)
Miami Shores Village RECEIVED
Building Department Vf_1
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 20IQ
BUILDING ... Master Permit No. 62P I q - ZC)g3
PERMIT APPLICATION CANCELLt® Sub Permit No.
DOUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
JOB ADDRESS: ?, LO 1I'r 0-3 %re
Fol
CONTRACTOR
DRAWINGS
s the Building Historically Designated: Yes NO
Occupancy Type: _ Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder)),:` Phone#:
Address: gg ) itc to 4����
City: i�(au 'irW►'Z-�j State: Ili Zip:
Tenant/Lessee Name: _
Email
r�
2u0 - $707
CONTRACTOR: Company Name:
rr 1� 1 `.� 1/� Phone#: ?g6 24( —4� gn
Address: I`La�f2. tJ ra.y -G�
City: �� Ck" r j_J State: - IA Zip: 7.3 i f�7 ,
Qualifier Name()�O iC,►' �i t ` A CO Phone#:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Certificate of Competency #:
ne#:
Address: City: State: p: . r
Value of Work for this Permit: $ 2Tv C/0 Square/Linear Footage of Work: 't
Type of Work: ❑ Addition ❑ Alter ttiion � New !�❑ Repair/Replacer ❑ Demolition
Description of Work: ' 3 J t/'��' bro- l c I l
Specify color of color thru tile: r
Submittal Fee $ � Permit Fee $ �C�(�� CCF $ (+U CO/CC $ �pp��
Scanning Fee $ r`"t " � GG
Radon Fe F3 ' " DBPR $ 12.• 60 Notary $ A
Technology Fee $ z'z_� Training/Education Double Fee $
Structural Reviews $ oz� Bond $ t� {��(-,C)
TOTAL FEE NOW DUE $ � T• V v
143-S
(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 an1d 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
N E R or AGENT
The foregoing instrument was acknowledged before me this
j6 7 day of U 20 (7 by
(35 Y� w FTrsF. �t/[uJk� [, who is personally known to
me or who has produced H—L L- as
identification and who did take an oath.
NOTARY PUBLI
Signatur
(4 - r, IM0
ONTRACTOR
The foregoing instrument wasFw
ledged beforeyge tAhis
d y of 20 by
who is personally known to
me or who has produced i1 W a_s�o 4.
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Sign:
hIY CUI/tWON MIT1190�13
Print:in,
4L
Print:
Seal
;�"'�.
DEVONYTHOMAS
( i0b�lS3
Seal:
* *:
MY COMMISSION # GG 017101
EXPIRES: August 1, 2020
.; of Fig:•'
Bonded Thru Notary Public Underwiters
BY
Plans Examiner Zoning
74APPROVED
Structural Review Clerk
(Revised02/24/2014)
Miami Shores Village `;C�ivED
Building Department U 171017
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 j1
FBC 20 t O
BUILDING winNCELLEff
aster Permit No.,
/�
PERMIT APPLICATION sub Permit No.�,C_ I 1-4 zo8H
❑BUILDING 1� ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: z; Q -'r � 2 4
r'ity• Miami Chnrac r'nnnhr Miami r)nria G 7in-
Folio/Parcel#: 1L
Occupancy Type��A_ Load:
OWNER: Name (Fee Simple Tiitlteholde
Address: 9 �V"A - 103
� 9
Is the Building Historically Designated: Yes
Construction Type: _Flood Zone: BFE: _
mWe
FFE:
ne#: 417D .16(6_ 11N)
City: A(QGLvi )" qL State: F1 Zip:
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name: Mo- -r/,o Cl Eli f G 15Z€ )1V / G2f Phone#�t /� 0 0 /7�
Address: lV21r '%o20 �!
City: Q/xfe&o I State:` iz, Zip:�f,-1
Qualifier Name: 1r1G l/0w1 Phone#:
State Certification or Registration M 13 CYQ531z2�sCertificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: �t City: State: Zip:
Value of Work for this Permit: $ ( Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration E? New ❑ Repair/Replace ❑ Demolition
Description of;Work:
Specify color of color thru tile: -
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $
CO/CC $
DBPR $ ` .• O Notary $
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 in
hure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice o . menc ent must b ed at the job site
for the first inspection which occur seven (7) days after the building permit is i the bse such posted notice, the
inspection will not be approved an reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
11 - % day of V 20 ' by
CAY,-//z- U1,46"-04who is personally known to
me or who has produced as
T
identification and who did take an oath.
NOT
Sign
Print
Seal.
Sign
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20 / 7 by
is personal)y known to
me or who has produced ��d'l/�j/1 ZILk7i&kJas
identification and who didAke an oath. , —7`0 ��
NOTARY PUBLIC:
Sign:_
Print:
Seal: (on
APPROVED BY4"s2=1' 1 < Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)