RC-11-16-3046 CanceledMiami 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
BUILDING CANCELLED
PERMIT APPLICATION
NOV 7 2-016
BY
FBC 20 i'`-('
Master Permit No. .A . / (V -, 3 0 i CND.
Sub Permit No.
(BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING [:]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 162 NE 106th Street
Cam: Miami Shores County Miami Dade zip:
Folio/ParceW#.11-2136-005-0030 Is the Building Historically Designated: Yes No no
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Brandon Simon Phone#: 916-662-5661
Address:162 NE 106th Street
City: Miami Shores State: Florida Zip: 33138
Tenant/Lessee Name: NA Phone#:
Email. Brandon_simon21 Qyahoo.com
CONTRACTOR: Company Name: Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration #:
Certificate of Competency #: _
DESIGNER: Architect/Engineer: JCD Architect, Inc. Juan C. David Phone#: 305-285-4343
Address:1385 Coral Way, Suite 207 city. Miami State: FL Zip: 33145
Value of Work for this Permit: $ eQ,21 boo Square/Linear Footage of Work: /!?y
Type of Work: El Addition INAlteration New ❑ lace Repair/Re p ❑ Demolition
Description of Work:
Specify color of color thru the:
Submittal Fee $,
Scanning Fee $
Permit Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ CO/CC $
DBPR $ 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 Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
— day of 20 16- by
71�3o&N32 ON �I COW S►f` ?Ao is personally known to
me or who has prod ucedfi-Ve(VE� �--I WCNM as
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. identification and who did take an oath.
as
NOTARY PU IC: NOTARY PUBLIC:
Sign: Sign:
Print: _ N� Q�—Qp— Le- .�Print:
�p�V' Y `f lY' fir` Y l✓ �' 'a' Y Y Q 'b' W 'YV y
Seal: =�<Y&� Notary Public State of Florida Seal:
Sindia Alvarez
9� o` my Commission FF 156750
OFf Expires09/03/2018
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)