RC-01-19-216BUILDING
PERMIT APPLICATION
BUILDING 8 ELECTRIC
Miami Shores Village ]?'�ECT�IVFJD
Building Department MAR 2 6 ZON
10050 N.E.2nd Avenue, Miami Shores, Florida 33138�, fL
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
Master Permit No.
r3ROOFING
PLUMBING ®MECHANICAL [:] CHANGE OF
CONTRACTOR
JOB ADDRESS: 6 0� 1
Sub Permit No.
r3REVISION
CANCELLATION
EXTENSION
SHOP
DRAWINGS
E3RENEWAL
City: Miami Shores County: Miami Dade Zip: 3 3 1 5 Q
Folio/Parcel#: - 0/ 2C) Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: gdyvy
Construction Type: Flood Zone: BFE: FIFE:OWNER: Name (Fee Simple Titleholder): M(C\ �Cyl ck Phone#: '9 q 6 ,,55 U - c ( �
Address: p H S 1 j W (q �� T-
City: l� � 6"V\( IS VtL State: L Zip: 3 3 ) 5 D
Tenant/Lessee Name: Iv, Phone#:
Email
CONTRACTOR: Company Name: N 11A Phone#:
Address:
Email:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: N Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: 9 Addition [3 Alteration ® New Repair/Replace ® Demolition
Description of Work: A i \ / b_
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ DCA Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ P&Z Review Bond $
TOTAL FEE NOW DUE $ 7 0 X30
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 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 appoved and a reinspection fee will be charged.
lilt /
Signature V Signature
OWN6 or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
day of �'�`�'r1 20 2-w by
hTfD ►ld G�uve , who is personally known to
me or who has produced )r Lt'c— as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_ LJ1 ��
���^ -
V Print: L V( �-yiru.- 1,01D
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:
as
Seal: \\\ Py P ,.//" Vivienne Yao
Seal:
Comm. MH222410
�..a� Expires:Jan. 31,2026
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APPROVED BY Plans Examiner Zoning
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Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
RECEIVED
J N 3 0 2019
BY•
Tel: (305) 795-2204 Fax: (305) 756-8972�
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 /--1-
BUILDING Master Permit No.
PE MIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
10B ADDRESS: 45N
oli /ParcelM [/ — '�) /O/ — 0
Occupancy Type:_ Load:
-7,1J Is the Building Historically Designated: Yes
Construction Type: _Flood Zone:_ BFE: _
OWNER: Name (Fee Simple Titleholder): I-htL nert ( MYA11- I�CX(ra&t Phone#: J
4.
Address: bi q6 &t
City: State:
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name:
Address:
FFE:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration #: ,, qq Certificate of Competency #:
DESIGNER: Architect/Engineer: �J �J f �� N Phone#: 3b '
Address 1 City: M IAkState: FI-1 Zip: ✓✓ t 4
Value of Work for this Permit: $ C� DOd• Square/Linear Footage of Work:
Type of Work: Ed Addition ❑ Alteration ❑ New ❑ Repair/Replace q ❑ De olition�
Description of Work: LT
D1Q1VFjWAq(J - WA91 F r�lDl4if OF Q ) 1 )
A"M Or l
Specify color of color thru tile: b ip MALA tX �5T)
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews $ 1 2-6' - l"l _
Double Fee $ _
Bond $
TATAI COP fdn%A/ n11C 1.
-TD
Bonding Company's Name (if applicable)
Bonding Company's Address
City State n- n Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address d - A2)1 G
City N04t y- State Zip S
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 copyy ofthe 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 fojegoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
LS C�1 day of aA 0& 20 J by day of , 20 by
0,Vk e,t M liJA- 6- who is personally known to who is personally known to
me as me or who has produced
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
as
Sign:
Sign:
f
Print:
Print:
Seal: — — — — —
Seal:
=01 RUCSANDRA A. M. TIPA
Notary Public
- State of Florida
Commission <GG 195070
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oonaed through National Notary Assn.
############################################### ###################
APPROVED BY
Q
Plans Examiner ) Zoning
Structural Review - Clerk