RF-01-24-212 CanceledMiami Shores Village
BUILDING
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
CANCELLED
PERMIT APPLICATION
FBC 20Z')
Master Permit No.
Sub Permit NO.91<
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
❑PLUMBING ❑ MECHANICAL ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOBADDRESS: 9/<,--�
Occupancy Type: Load: Construction Type:
the Building Historically Designated: Yes NO
Zone: BFE: FFE:
OWNER: Name (Fee
_Simple
pTitleholder): JZf�J £Z "�D2/[ F Phone#:
`I Ca s Address: 1 Y � (/
City: IL*AMl State: Zip: 3 3 1 3�
Tenant/Lessee Name:
Email:
CONTRACTOR: B Company Name: J �� Sw ?'7 Ue 72 dAO
Address: I /J q C7 --'L�10 15- c
Email: \,rAj ✓ P£n U 711 l
7f/Z vz
Cd M
Qualifier Name: \'Toxcp 1141C'A R P F z Phone#:/�74G/ y'F9/ -7 -3
State Certification or Registration #: G C /'3 a` a 97 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Email: h �
Value of Work for this Permit: $ 3 / p O o. Oo Square/Linear Footage of Work: [
_ / 0
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: �1'�i4 dX- sp�'I S7/,14; %/ L I ?t (/✓ S 4 %r T(Ewl O &W
Specify color of color thru
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $
DCA Fee $
Training/Education Fee $
CCF $_
DBPR $
P&Z Review $
I- zy- Ztz
CO/CC $
Notary
Double Fee $.
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
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 ail
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 $1500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the jab site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of
me or who has produced
20 by
who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
APPROVED BY
as
f
Signature ,
CONTRACTOR
The foregoing instrument was acknowledged before me this
lD day of �U( 202' by ,
�t¢ k \%�L 006ho is personally known to
me or who has produced (-�L D2ky+42 as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Plans Examiner
ARLENIS SILVERA
Zoning
(Revised04/26/2024)
Structural Review
Clerk
914
67
•-7V,- yRq_ 173�
Miami Shores Village RECEIVED
Building Department JAN 91 2024
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 2023
BUILDING Master Permit No. PF-6I-Z4-212
PERMIT APPLICATION Sub Permit No.
®BUILDING ® ELECTRIC WIROOFING ® REVISION ® EXTENSION ❑RENEWAL
[]PLUMBING ❑ MECHANICAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
�J CONTRACTOR DRAWINGS
JOB ADDRESS: /� 9a 5" N E % I T&&z*ez
City Miami Shores County Miami Dade Zip: 3 S 8'
Folio/Parcel#: //' 3 aD6 - DO 3 - Oo6o Is the Building Historically Designated: Yes NOy
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):. A NI f Z TDR/L `wi Phone LO V, Lfy.,/ 81 Z9
Address: 9 a'S N 6 91-T X'z"GC
City: M141-71 sh'k" " State: f'L_ Zip: 33 i3$
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Cp.�lS?�yGT�O'V Phone#: 7 J 'fl9q/-73 -7
Address: //ray 3 D SIO Sr} Lfwl^—
Email: LL-!V �F•QU .7 A • �7ni' p
Qualifier Name: 0,r,76,c Q G'• &e-er< Phone#: i� / 9
State Certification or Registration #: e-- a C Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: ^ City: State: _Zip:
J Value of Work for this Permit: $ 104 6 • ' Square/Linear Footage of Work: if /F'A i /�73-7
r
Type of Work: ❑ Addition ❑ Alteration ® New /® Repair/Replace ® Demolition /
Description of Work: m0✓f �X/STZ�� R40r7-/L,F i" I VSTAI/ A/FeyI/zX //7'/"0/'E
.sl9�r/"f"y fy�F
Specify color of color tAru tile: �a01 a d 5 % %3LFtio (t A' P
submittal Fee $ SZ.6D Permit Fee $ 13S. 70 Z3. 70 CCF$ ( 9. 2.0 CO/CC $
Scanning Fee $ 7 U . (:b DCA Fee $ to .G? 4 DBPR $ '1 14 Notary $
Technology Fee $ i,7 0 •9 u Training/Education Fee $ t I too Double Fee $
Structural Reviews $ P&Z Review $ Bond $ --ff
TOTALFEENOWDUE$ (005, !!
(Revised04/05/2022)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lenders Name (if applicable) _
Mortgage Lender's
City
State
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 $1500, the applicant must
promise in good falth 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__ zl /r:)Qnlel70YIt-b• Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20 6� .by
?tYu+6 %02 12CS . who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: QC} LJ L20/, nco-
Seal:
Expires 0526+2025
(Rwisedo4/05/2022)
of Florida
The foregoing instrument was acknowledged before me this
�4 dayof� C� .20q .by
]F0eG F �d // CA 2Ce' 1 , who is personally known to
me or who has produced FD (--
Identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: C�e:',PfP�itJ �OfJPS�
Seal: -- --- ------ --- -- -- --
Examiner
Structural Review
Notary Public Stale of Florida
Zoning
Clerk