BP05-1071Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.220❑4�Fax: (305) 756.8972
BUILDING
E � �! EI Permit No. 6'LL2510�
PERMIT APPLICATIO JUL 2 D 2605 f Master Permit No.
FBC 2001 - -
Permit Type (circle) • uiidin / Elec ric Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) IV('JJ Phone #
Owner's Address f S a A.). &, 0
Citymm ( �'kOe& State rVI Zip51�' _
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 15;L,r P ,b 10q S7"I
city. Miami Shares Village _ County Miami -Dade Zip
Is Building Historically Designated YES NO_-Y
Contractor's Company Name. pt] C_ Phone
Contractor's Address 6ajQ&SW-�
City 1i411,,4A / h4A6�
_
:Zip . 3 3 o 0 S
Qualifier H Y0 Gv !f9A) - ..
Architect(Engineer' Name (if applicable) ]TI { A>00 ] _ Phone #
$ Value of Work For this Permit gz3 G� 31
Type of Work: Addition ❑Alteration ❑New
Square Footage Of Work:
❑ Repair/Replace ❑ Demolition
Describe Work:
��►fir.:•rr�r�mn��cs►ir.�►��s:.�r.rE
r ■i r
Submittal Fee $ Permit Fee $ - CCF $ 0,140 CO/CC
Notary $ �� Training/Education Fee S �• Technology Fee $ (p Dye
Scanning $ CQ Radon $
Code Enforcement $ r—
Total Fee Now Due $
(Continued on opposite side)
�� Zoning_ _
Structural Plan Review. $
Bond S
COA C- '41MOO
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 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 pasted notice, the
inspection will not be a r ved and a reinspection fee will be charged.
-y-4iignature Signature
Owner or Agent Contractor
The Fox going instrument was acknowledged before me this
day of 20 =� by � o J �.11��-•
who is erson
y known to me or who has produced
4a`EO7 � As identification and who did take an oath.
The fopgoil: instrument was acknowledgedpefore me this
day of 200S by � 11 0 a2A
who is person y known to me or who has producedTo IV
as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: �' -- - - Sign:
Print: Print:
My Commission E.xpir NOTARY PUBLIC -STATE OF FLORIDA My Cormllission ExpirqqOTARy PUBLIC�STATE OF F,OR
zMa
mmission
*Emires: Jay
A-D4 7cate of Competency Holder) Commission #1DD437505
Bonded Thrui Adagdc 8 0 o., Expires: JUiY OI, 2009
State Certificate or Registration No. [ e [] ['} � 6 4 _ Certificate of Competency No, Bonded r', 0 `16andc Bonding co, Inc,
APPLICATION APPROVED BY: G
Chc 12/15/03
I' `l Plans Examiner
Engineer
Zoning
I illlll I I III lilll III If III II II Ill IIIII lil I it
OF'N 21305RO241812
OR Bk 23158 Ps 3580; (1p9)
RECORDED 03I11I21305 10 ' 4u d 14
HARVEY RUVIhlr CLERK OF COURT
NOTICE OF COMMENCEMENT MIAMI-DADE COUNTYP FLORIDA
LAST f'A5E
A RECORDED COrYMUST BE POSTED ON THE Jos SITE AT TIME OF FIRST INSPECTION
PERMIT NO.
TAX FOLIO NUMBER: �I-a�`�a �G�-d gV STATE OF FLORIDA, COUNTY or DAB � k
- -I FaRtey CERTIFY that Ihz fa copy of the
l nucI IL
C
online► nl l6 rc
STATE OF FLORIDA: p
COUNTY OF DADE• yr MIC. S mi handa++d � W
HARVEY UVIN, CL'c f , !; IrfS � w ec.n• i`i%
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real prcpe . nd in accordance with Chapter 713. Florid;
Statutes, the following information is provided in this NOTICE OF COMMENCEMENT.
1. Legal description of property and street address-
.,n r- A,e r_ /n4o ( Iff, m , A4 t Srla94f Fi L
2. Description of improvement: in&tj111 hum hu rs
3. Owner(s) name ame�nd`` address: n (acidIn
re pU, Ah , 10 1 1
Interest in property:
Name and address of fee simple titleholder:
4. Contractor's name and address: Rolladen Inc 550 rl in Blvd.. Hallam AI FL 33At78
5. Surety: (Payment bond required by owner from contractor, if any) n1a -
6. Lender's name and address: _ n/a
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as
provided by Section 713.12(1)(a)7., Florida Statutes.
n me) rqrIr1rP..qq1
8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided
in Section 713.12(1)(a)7„ Florida Statutes.
9. Expiration date of this
Notice of Commencement- (the expiration date is 1 year from the date of recording unless a
different date is s
Signature of Owner:
y�
f'Ptint Owners Name'
Sworn to and subsuibel4foRlp
me this day of 2(1eg;Qk:�- 20e!S._
Notary Public:
(Notary
Prepared by and return to:
/Stamp) �p
- A4
C.R CURTis Rolladen, Inc.
Notary Public - State of Florida55() AnsinBlvd.
NVC0m-i& �E r-esAprI8,2008
rI-
Hallandale, FL 33009
Commision # DD294277_Bondad
Hv N tion�I NotaryAssn.
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