DS-6-15-1552 CancelledMiami Shores Village rp
Building Department JUN 23 2015
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 lei
BUILDING Master Permit No.
PERMIT APPLICATIO 2'0 Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION} RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
j�) 14d CONTRACTOR DRAWINGS
�7
JOB ADDRESS: / (7 4 V � / �/ � 5
Citv: Miami •Shores County: Miami Dade Zip:
Folio/Parcel#: 1 r� ��y Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: _Flood Zone: -� BFE: FFE:
J
OWNER: Name (Fee Simple Titleholder): l� �{ Adle 'nonee#x ❑ 2J ..7 ,;,
Address:
City: /
Tenant/Lessee Name:
Email: ►r,/ /j O
rl State:
IJ 8'/ OX 09 /47Y
hone#:
•
CONTRACTOR: Company Name: 0, t/t/n nZ60-I' J Phone#:
Address:
City:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
State: Zip:
Phone#:
Certificate of Competency #:
Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work: p fa
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition
Description of Work:
0— 1
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
Technology Fee $,
Structural Reviews $
Radon Fee $
Training/Education Fee $
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
E.
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature.,/4e
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of 20, S _, by
/Y��rrrL , who is
personally known to
me or who has produced `T/ as
identification and who did take an oath.
NOTARY PUBLIC:
Signature,
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of
me or who has produced
70 , by
who is personally known to
as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: Sign:
Print:
Seal:jc �atarypy ics'a Seal:
!0 Of Ff Or+tle
ur C0rmMiloeliclano
exprm, aa/r�nai$ °ea�s3
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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
BUILDING Master Permit No. .{ �-15- Ifs Z
PERMIT APPLICATION Sub Permit No.
BUILDING ® ELECTRIC E3 ROOFING REVISION E3 EXTENSION ORENEWAL
PLUMBING C3 MECHANICAL ❑ CHANGE OF Of CANCELLATION [3SHOP
f /j� CONTRACT � DRAWINGS
JOB ADDRESS: / . / u � 1&2AA
City: Miami Shores / County: Miami Dade zip:
Folio/Parcel#: tl `r l%6 '` �r ` r -4 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder)- :_�: r Xr��%��/� Phone#: �
Address:"'�
City:
Tenant/Lessee Name:
Email: Z;,A5A
State:
CONTRACTOR: Company Name: Phone#:
Address:
Email:
Qualifier Name: Phone#:
State Certification or Registration #: C rtificate of Competency #:
DESIGNER: Architect/Engineer: _ Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $_ d Square/Linear Footage of Work:
Type of Work: ® Addition ® Alteration 0 New
® Repair/Replace ®Demolition
Description of Work: v P r d� 1�
Specify color of color thru the:_
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $ CCF $_
DCA Fee $ DBPR $
Training/Education Fee $
P&Z Review $
CO/CC $ .
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised04/05/2022)
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 persan
whose property 1s 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 approved and o re inspection fee will be charged.
Signature ) Signature_
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
_ day of -� cAIJO—�- , 20 Lq by
Way tar &rAectik . who is personally known to
me or who has produced J�Z �� t��s (✓ [� _ as
identification and who did take an oath.
NOTARY PUBLIC:
The foregoing instrument was acknowledged before me this
day of , 20 , by
who is personally known to
me or who has produced _ as
identification and who did take an oath
NOTARY PUBLIC:
Sign: Sign:
Print: (VtL _►1 VV Print:
5N.
i1MPH VivienneYao
\nY....
: tip COMM.
Seal: :o� e�:• 0222410 Seal:
?:
,,. Expires: Jan. 31,2026
Notary Publle - Stale of Florida
APPROVED BY
Plans Examiner
Structural Review
Zoning
Clerk
(Revised04/05/2022)