WS-08-17-2197 CanceledJ
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
%_.P%NCELLED
WTVR1D
0 T 12 2017
V.
FBC 20 Iq
BUILDING y 12. � 2_0a.4 Master Permit No.
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
❑ PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
I 1
City: Miami Shores County: Miami Dade Zip•^' 3 6
Folio/Parcel#: 11 (� c9 13 'Ui�. 3 `U 1 ) Is the Building Historically Designated: Yes NO
Occupancy Type: Load:
OWNER: Name (Fee Simple Title[
Ad
Construction Type: Flood Zone: BFE: FFE:
`, tf✓1�i�1-l'1 �"�� V'1 ( �r� Phone#:
City: IQ ��i �/e S State: Zip:
Tenant/Lessee Name:
Email:
one#:
CONTRACTOR: Company Name: - G ' clul yr d.: $�i . —� ; Q. Phone#: ;) V o_-fir
Address:
City: C--C.A 0 �� state: -i'� Zip: 3 F3 : 1
Qualifier Name: $ i Phone#:
State Certification or Registration #: i ' c `' [ �,L , Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address:
Value of Work for this Permit: $
Type of Work: ❑ Addition ❑ Alteration
Description of Work: Ca no'd nery'
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $,
(Revised02/24/2014)
Permit Fee $
Radon Fee $
Phone#:
City: State: Zip:
Square/Linear Footage of Work:
❑ New ❑ Repair/Replace
Training/Education Fee $
v�
CCF $
DBPR $
❑ Demolition
CO/CC $ _
Notary $
Double Fee $ _
Bond $
TOTAL FEE NOW DUE $
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 ha:
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulatin{
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 al
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAN
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTENE
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 mus:
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the persor
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 GEN CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of Cz�, 20 I - by —I—� day of 20 _(% by
�_�i��'Yl.O. ZI �_ who is personally known to J�_h �i�� who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Print: /
I/
AGELAYO'N
Seal: „ ,^
MY COMMISS*4- F 951069
*�,FJ *
EXPIRES: Agri; 12. ?;`20
lFOF F�o�
Bondad �hri, �'udgar Notary Sarnc_s
APPROVED BY
identification and who did take an oath.
NOTARY PUBLIC:
S i g rq..-
Print:
ANG YOUNG
Seal:
MY 1h41SSION 9 FF 951069
tAIKI
EXPIRES.AD6 12.2020
\ 77 \
EwOzd d "hr 6-udgEt Notary Seri:,<
Plans Examiner
Structural Review
Zoning
(Revised02/24/2014)
Clerk
—1-16 UJhc3w,
� � c-� c CTV-1 V-\ -2�
?-e-4 V�- � i S— 3�
(�-1 N w c o S s 1. WakL1',
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
BUILDING
PERMIT APPLICATION
�UILDING ❑ ELECTRIC ❑ ROOFING
Master Permit No.
Sub Permit No.
RECEIVED
G 3 0 Oi17
Sn `� l
FBC 20A�
WS 1=1-21�1�
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: / /•, / 0 (A) /c, 9 -�'4 - ---
City: Miami Shores County: Miami Dade Zip:;
Folio/Parcel#:/ f -6� l t -0G (1 (') Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): jon,,�) L o HL)a Phone#: !' =V7 I I'S-3 7
Address: N„--� &/,/l) i09 51
City: H 1 0/0 J 00f"
Tenant/Lessee Name:
Email:
State:
hone#:
CONTRACTOR: Company Name: Phone#: ',�) Cc0: c
Address: N �>,ALc \ �-? C.i ,1: t f�*:�-y
City: �,L?C� \ T \ � C—.T (�� �.rState: Zip: 3 "3 `` j / D-
Qualifier Name: JC.c ►rY1 �) ` \) 't �J Phone#:
j
State Certification or Registration #: ' r �-.� j Certificate of Competency #:
DESIGNER: Architect/Engineer:
Phone#:
Address: City: State:
Value of Work for this Permit: $ / �, ( T Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace
Description of Work:
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
�5 �
Permit Fee $ \ CCF $
Radon Fee $
Training/Education Fee $
DBPR $
Zip:
❑ Demolition
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 alll
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 mustl
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, thel
inspection will not be approved and a reinspection fee will be charged.
Signature ignatur
OWNER or AG NT CONTRACTOR
The foregoing instrument was acknowledged before me this
J day of J 0 20 i by
QLJ -Ifrim who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign.L
Print: C/ v
Seal:
s N11' COMMISSION # FF 951069
* s x
EXPIRES A,>ri 12 :0
yTFCIr 'tb'�� 6onilYi 71, .,H..i it Wn 1`.
The foregoing instrument was acknowledged before me this
(_ day of ICE 20 by
i� who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
as
Print: zg4a6a
/�f/l r
Seal: a -�*
N11 COMMISSION fi FF g
U _ z
EXPIRES: ADn. 12 '0
5,ndA hf. 9udget Nnt.,
################################ # # #####################################################################
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)