DEMO-12-19-3025 CanceledMiami Shores Village c i ED
Building Department DEC 3 0 019
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: t4
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (MS) 762-4949
CANCELLED ��F�BC 20
BUILDING Master Permit No1m0
PERMIT APPLICATION
�
ahy L
Sub Permit No.
❑BUILDING ❑ ELECTRIC
❑ ROOFING
❑ REVI N
❑ EXTENSION ❑RENEWAL
❑PLUMBING [—]MECHANICAL ❑PUBLICWORKS
JOB ADDRESS: 9100 N. Bayshore Drive
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-3205-001-0560 Is the Building Historically Designated: Yes NO X
Occupancy Type: RES Load: Construction Type: demolition Flood Zone: AE BFE: 10 FFE:
AV Vci .4,sa soil=_
OWNER: Name (Fee Simple Titleholder: Phone#: L4
Address: a9/00 //' C3/9(/ slxJ/1E' )D 2
City: State: T-- zip: 33
Tenant/Lessee Name:
Email:
rrmgn - �Pm
Name: / ` �LLr�/771% G''�5 { /UG 3 / �� 76
CONTRACTOR: Company �Phone#:
Address, ;7 / C/ 62 _�� �1 ✓� l,�
City: ) �'A—N o S 5;Z 1= State:- Zip: '_�g Oy
Qualifier Name:. �T � ) Phone#: lS� D�7l
State Certification or Registration #: G Uv / Certificate of Competency #: J
DESIGNER: Architect/Engineer: Jon Olson 1 b77 ( (DP, I DA Phone#: 561-262-0387
Address: 308 tequesta dr. unit 26 y city: tequesta State: FL Zip: 33469
Value of Work for this Permit: $ 5,000 Square/Linear Footage of Work w t C)0
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace IN Demolition
Description of Work: Interior removal of finishes, oaf knet waf)s; and demo
door and window openings per plans
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
DBPR $
Notary
Double Fee $
Structural Reviews
(Rmsed02/24/2014)
Bond $
TOTAL FEE NOW DUE $ l u
Bonding Company's Name (if applicable) v�
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 CONDMONERS, 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 �./�1� �12
OWNER or AGENT
The foregoing instrument was acknowledged before me this
+h ay of oe c{ m tic r . 20 I lq , by
Flit � �� —'�)/4 who is personally known to
me who has produced D g iy 1 � [A(P nse, as
identification and who did take an oath.
CONTRACTOR
The foregoing instrument/warms acknowledged before me this
aCday of/)�CC"7� �2 20jr�by
who is personally known to
me or who has produced PR UE7ZS as
identification and who
NOTARY PUBLIC:: NOTARY PUBLIC:
Sign: Sign: \
Print: ql�Z 1,CX q (5 Print: YE1/110
Seal: M::+ •• MARISOL PICHARDO Seal:
/
MY COMMISSION # GG087798
EXPIRES March 28, 2021
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APPROVED BY
Plans Examiner
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OFI FLOR\������\�
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(Rmised02/24/2014)
Structural Review
Clerk