RC-01-20-228 Cancelled�.FCEIV�Ij
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 NUMRER: (3051 762-4949
FBC2040g111
Master Permit No. F,6
Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF
! /7 /VvV ?,�—
DNTRA
JOB ADDRESS:
NCELLATION ❑ SHOP
DRAWINGS
✓,!�/J
Folio/Parcel#: I l r ✓ / ) 1 ^0 3 �>, !� () V(�) Is the Building Historically Designated: Yes NO
Occupancy Type: f Load: ]Construction Type: j Flood
Zone:/ h" (�7 BFE: FFE:
OWNER: Name (Fee Simple Titl hol D er):T Lr �.lC�! I _ L - p hone#:
Address: dZ
City:
Tenant/Lessee Name:
State:
Pho
Email: �1
CONTRACTOR: Company Name: r '✓ v �n ` �" — Phone#:
Address:
p: E;��Je)
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency M
DESIGNER: Arc ' ec Engi r.�j ` Phone#:
Address: Q I City: +f ' ?
Value of Work for this Permit: $ 5 O� I) Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New/ Re r/Re lace
Description of Work: 'C �V r �A� j r b
Specify color of color 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 $
(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 approved and a reinspection fee will be charged.
Signature !� � e Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
2A day of _ QJ�C__�20 I by
U - i ho is personally known to
me or who has produced PL< 1—�VrCX as
identification and who did take an oath.
NOTARY PUBLIC:
Print:
The foregoing instrument was acknowledged before me this
day of
me or who has produced
20 . by
who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
It GG Sign:
IA�s: na° Print:
Seal: °=wo, Seal:
APPROVED BY
Plans Examiner
Structural Review
as
Zoning
Clerk
(Revised02/24/2014)
N� I�c�f(�-
a4l�14. fa/dd���
cw)t/,(/L
/,-�-47 / Dr-,
BUILDING
PERMIT APPLICATION
Miami Shores pillage
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 79S-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
C JF4I VE�D
A1\1 ;1 i {,D20
BY:1!,
FBC 20
Master Permit No. -RC — 01-2.0 M
Sub Permit No.
BUILDING fml ELECTRIC 0■ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑■ PLUMBING �■ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 117 NW 92nd Street
City; Miami Shores Countv:
Folio/Parcel#: 11 -3101 -033-1040
Occupancy Type: R-3 Load: Construction Type:
Miami Dade Zip:
Is the Building Historically Designated: Yes X NO
food Zone: /A BFE: / FFE: +9.9
OWNER: Name (Fee Simple Titleholder): AVERILL DORSETT
Address 117 NW 92nd Street I
City: Miami Shores State: a
Tenant/Lessee Name:
Email: averill.dorsett@gmail.com
Pi,one#; (305) 799-1505
phane#':
Lip: 33138
CONTRACTOR: Company Name: Owner -Bull r Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Victor J. Bruce Phone#: (305) 310-5030
Address: 370 NE 101 st Street City. Miami Shores State: FI Zip: 33138
Value of Work for this Permit: $ 50,000 Square/Linear Footage of Work: 200 sq. ft.
Type of Work: ❑ Addition E Alteration A New ❑ Repair/Replace ❑ Demolition
Description of work: Interior Renovation of existing Kitchen and the removal of a structural support.
Specify color of color thru tile:
Submittal Fee $ ZLY] }7G �� 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 $
(Revised 02/24/2014)
14 PC, Cffs
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
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: 1 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 n be approved and a reinspection fee will be charged.
Signature gi,Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
ASP day of 20_ 0 by
L--bQMSz � -i , who is personally known to
me or wizo has or -ad uced —DL as
Identifi atibn a d who♦did take an oath.
OTA Y PUBLI
r�rrrrrrr
Sign: ♦ �
r rY � - Jy7C� � • J
Qr�
Print:
r�
=�
Seal:
�'i'/� eR�615 '• ti
APPROVED BY
The foregoing instrument was acknowledged before me this
day of
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 Zoning
L Structural Review
(Revised02/24/2014)
Clerk