DGT-12-20-2964 CanceledMiami Shores Village
Building Department MA( ! 0 2024
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ::;. ty _
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
CANCELLED FBC 20
BUILDING 5 12 I +wZy Master Permit No. DG 2 20 2g
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ PLUMBING ❑ MECHANICAL ❑ CHANGE OF f4TCANCELLATION ❑ SHOP
n AlONTRACTOR DRAWINGS
�/
JOB ADDRESS: I �`� I / J% 9y � f�
City: Miami Shores County: Miami Dade Zip: 35 /3 $
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zane: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): ryry—��0` "`" J'en"'�'e Phone#:
Address: (29� ti� /�✓T
City: MJ� ` S�ofef State: J
Tenant/Lessee Name:
Email: � j �.1 ems' M'L- CO.9fV;k' r-Y7
CONTRACTOR: Company Name:
Address: loq cm4p-1
Email:
M Z Des-'J'l
W.
+r7
1`
33�3�
e#: �f 6! —76 66
yq
Qualifier Name: I ' ( I"lo � Phone#: rag G C36 �
State Certification or Registration #: �%� / 1 y 3° Cl Certificate of Competency #:
DESIGNER: Architect/Engineer: �F Kr S "A ( Is{�' ^ Phone#: �32 g 3.3
Email: /
Value of Work for this Permit: $y r 3,3 2 Square/Linear Footage of Work: 2310
Type of Work: ❑ Addition ❑ Alteration ❑ New ® Repair/Replace ❑ Demolition
Description of Work: it (' Ina c L f o.o) aecv V l h r)r--j W o,ve1 oLeC L'
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 $
(Revised04/26/2024)
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 oppcoved-and a ,einspectiop fee will be charged.
OWNER or AGENT
The ftiregotng instrument was
CONTRACTOR
this The foregoing instrument was acknowledged before me this
day of IU6L 1 . 20a4 , by
��1 �;�^2� , who is personally known to
me or hoCas produc d %CkR .k1iktC I,,C as
identification and who did take an oath.
day of 20 by
who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
as
Sign: l �
Sign:
Print:
l �(
Cf�J /lC��
Print:
Seal:
.tip.• =,e.. KRISTINE KEPPLE YAO
Seal:
Notary Public - State of Florida
.y Commission X HH 452227
'
My Comm. 2027
uExpires IOct t8.
APPROVED BY
Plans Examiner
Zoning
(RevisedO4/26/2024)
Structural Review
Clerk
I \Z-/ /o /-�- ty
C�r'ce �
12 W C-,4,e A�bmev��-ems, l�e�er
4ve tj o o ,)
aeC OeAj GAJ o Otec p c-r- �4C:-
S)4b,,,1N. �.r � �, a r-,3,e� q
-�.2-22-7)
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
BUILDING ❑ ELECTRIC ❑ ROOFING
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
Master Permit
Sub Permit No
RECEIVED
i : C 4 2020
< <A
FBC 20
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I Z 9 I TAT --
City: Miami Shores County' Miami Dade A? Zip: --5
Folio/Parcel#: Is the Building Historically Designated: Yes NO -
Occupancy Type: Load: Construction Type: _Flood Zone:%1�BFE: FFE:
OWNER: Name (Fee Simple Titleholder): jc?r, A+%,4n , em -.e Phone#: go' may- g81.S
Address: 1Z9 \ ora !94-m tJkfec- . t+
City: ijoi! S�rof�S State: Yf - - Zip:3313�
Tenant/Lessee Name:
Email: I o,,\e.r—o Me
CONTRACTOR: �tCompany Name:
Address: 104 ( rar&r
City: VDC
Qualifier Na
State Certification or Registration #: G1c— 1z-5 Certificate of Competency #:
=_Sign M r� Ph_one#:�' 7L li —9335
XCity:r[jamt t))y-0C1l StateFt.Zip:33� ko
Square/Linear Footage of Work: $�
❑ New K Repair/Replace ❑ Demolition
,/. Gom
DESIGNER: Architect/Engineer: �7I 1tV 1
Address:9� /� ]bQ( L>n(]lr
Value of Work for this Permit: $tr
Type of Work: ❑ Addition ❑ Alteration
Description of Work: [C4,&LQ r'iy
)"r Z
Specify color of color thru tile:
Submittal Fee $T7 D' CD Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
Phone#:3 o5 JU(,.) 696
CCF $ CO/Cc $
DBPR $ _ Notary.
Double Fee $.
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $
L
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 o reinspection fee will be charged.
Signature/
OWNER or AGENT
Signature
a
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instr ment was acknowledged before me this
15 day of e- 20 �� by /1�& day of VeCeVAbell 20 ZO by
3a-rAWy t(I P17J who is personally n5"0 V who i ersonally kr to
me or who has produced as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Print:
identification and who did take an oath.
NOTARY PUBLIC:
ksN
Sign:
Print:
t C
Seal:
,f. B94
3
"�� • i8hiek
'N9i� Sr4,h OF
APPROVED BY Z/ Plans Examiner 1� Zoning
Structural Review
(Revised02/24/2014)
Clerk