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PW-20-148Y N BUILDING PERMIT APPLICATION 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 FBC 20 Master Permit No. T Q '-0) Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS 73 P Q c I 0 " 7 JOB ADDRESS: City: Miami Shores County: Miami Dade zip: 33)C. Folio/Parcel#: Z 1 -0 Is the Building Historically Designated: Yes NO Occupancy Type: S'iv L't Load: Construction Type: bL )t Flood Zone: IN'6 BFE: FFE: OWNER: Name (Fee Simple Titleholder): 1W 19w � (-�1"`� Phone#: 60r.301 YZ" Address: b ) N V N `��' City: iN1 I Ay-, Sl,,,rc-S State: Zip: 3-31 Tenant/Lessee Name: Phone#: Email: 1;M" . Fl,-r,-� 0 C-1w*i L CONTRACTOR: Company Address: 30_5�6 Name: �trrV�1S Phone#: -3057 City:' 020 Qualifier Name: �iM`�- State: FL O t Zip: 37L\5-� Phone#: 15 S L y(-y State Certification or Registration #: Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: Address: City: State Value of Work for this Permit: $ Square/Linear Footage of Work: _ Zip: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 'D/ I V wq 0 w ilk 5 �i Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Technology Fee $ Training/Education Fee $ Structural Reviews $ _ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ (Rev1sed02/24/2014) 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 on 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 nd a reinspection fee will be charged. Signature Signature (O RorAGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this M me or who has produced w J is personally know�i as identification and who did take an oath. NOTARY PUBLIC: , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: L�w S \ AVLk UOOJ—�0'cx� Sign: Print: l . V' Y i syk vi -p— w�.��( o tc0 , Print: I — Seal: W01* Seal: ;. CQI'ri'l#Og9gg�g APPROVED BY (Revised02/24/2014) A -Qk � Plans Examiner Structural Review Zoning Clerk ft BUILDING PERMIT APPLICATION ENXERED Miami Shores Village JAN 22 2020 Building Department BYs 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 (AV, FBC 201� Master Permit No.BN - O I "2Q- I+8 Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING [--]MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP ?? C CONTRACTOR DRAWINGS JOB ADDRESS: /� J �� / O � } \ j- City: Miami Shores County: Miami Dade zip:3%� Folio/Parcel#:j 1 - 2,13 � —e l ( - 0q-10 Is the Building Historically Designated: Yes NO Occupancy Type: Siti4k Load OWNER: Name (Fee Simple Titleholder) Address: City: _ Tenant/L Email: \ CONTRA Address: Construction Type: T3 LK Flood Zone: 10-4.) BFE: FFE: 1-: City: v. t— 0 c' � -, State: C • L Zip: �3 0 S N Qualifier e: C-S t-1- e--- c.er-� 1 c:f> i� eP C2 / E Phone#: '7 5— ce -.s State Certification or Registration #: Certificate of Competency #: 9 Z C"✓ C'� j DESIGNER: Architect/Engineer: Phone#: Address: City: State: Value of Work for this Permit: $ LZ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New `mil Repair/Replace Description of Work: of I Vei�A \1 D " � 1 P�)� / 0� LOA� 1 Zip: ❑ Demolition 4Slb�L-r Specify color of color thru tile: Submittal Fee $ Permit Fee $ - CCF $ °i" " CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) �-`)« :1,35� _ -.,ice � .i�,•- � t .i , ' • 4 - I � ,. 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 IMPROVEMENT i Q YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING. CONSULT WITH YOUR LE-NDW AN ATTORNEY BEFORE RECORDING Notice to A licant: As a condition to the issuance o a bui�ing permit with an estimated value exceedin 2500 the applicant must PP f 9 P 9 $ PP 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 b pp oved and a reinspection fee will be charged. Signatu Signature /Z_ C/ CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 5(\WU-P1�—q , 20 �;Iy by day of 1AIIIII)Q90 20 a0 by �0�F'-t �t� J)12 `1��who is personally known to l�)� T00 who is personally known to me or who has produced—�� me or who has produced as identification and who did take an oath. NOTARY identification and who did take an oath. NOTARY PU Sign: Sign: /� 5t �� JQr1U ��11I Hllll �102CI,Or``,N' Print: \ r�C? Print: GARC Seal: �,�,,; SINDIA ALVAREZ al: r4agF' MY COMMISSION 11 GG 238273 ^ • �� P ,Fur i °� EXPIRES: September 3, 2022 Bonded Thru Notary Public Unde�abra ' p®<'s`s �P, � J==�'�� APPROVED BY Plans Examiner Zoning W„sNx, "'SIN Structural Review Clerk (Revised02/24/2014) plowc- JJ04.Kq f Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 766.8972 CFN 202OR13042449 UR BY. 31780 Ps 4468 UP90 RECORDED U1l15/:2!121-1 IL1.05 52 HARVEY RUVIN� CLERK Uh WURT MIAMI-DADE COUNTYr FLORIDA COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY Whereas, (owner)_ 31a S +'►l:��i�� = i` hereinafter referred to as the owner of the foil wing described property (address): 73 tJE / 0S 4 %- S! Legal Description: Lot Block ziS Subdivision 5 5 �a►n, 51� �� -Folio # - — ---- --- Requests permission to install (describe work): "S j&4L-I- 5 Within'the public righf of way of (address) _ 3 M r IL,S ��•,�, � cs � �, 3 31 I.1 IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows: 1. • To maintain and repair, when necessary, the above -mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. 2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to: be removed and a lien being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligations has been canceled by an affidavit filed in the Public Records of Dade County, Florida by the Village Manager of Miami Shores Village (or his fully ay#horized representative)_.. Signature Owner or Agent State of Florida County of Miami Dade The foregoing instrument was acknowledged before me this 1 day of U 1 , 20 'Zo , by .J0SI�LP,i Ii QQT�P) who is personally known to me or who has produced identification. NOTAR PUBLIC: .; •. SINDIAALVAREZ Sign: ', t! MY COMMISSION # GG 238273 Print: <r� UNTOFDADE Cou L: ,�d, EXPIRES: September3,2022 c" I HEREBY CERTIFY Pat thh is a bva y of" � cu■. " g , Bondod Thru Notary Publk un wmbrs J O ofloal tiled m t" OMB* on der et at: J AD � • � t WitNE'SS my han snd Offtal Saet. tikR Y RUVIN, CL • alC'G�r��¢c�Caurts