RF-2-12-235 Canceleda Miami Shores Village Ho 0
BuildingDepartment p artment
BY:_ ---------------_
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECT j � ftt.NVj0ER: (305) 762.4949
ED
BUILDING re P t a � I 9F_ I z 457-3178 Permit No —
PE PPLICATION Master Permit No.
FBC 0
Permit Type: BUILDING ROOFING y
OWNER: Name (Fee Simple Titleholder): 1QS/V6U Q 2 Spl� 1,14
(/ • Phon #( — ��
Address: R/ 1 AV-7_Zfi
City: " State: 6 M—t D Zip: 33
Tenant/Lessee Name: / Phone#:
Email:
JOB ADDRESS: 16S NO) 9a Xa EUIM, 7_�
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Comp Name: ! G •Phone#: 6S
Address: AW Z
City: State: Zip: '7y•�_[�
Qualifier Name: All Ayh i2 Q � ILL Uc kc S Phone�3_FS); '
State Certificati/oR or Registration #: GG GOf� ,, j 06 Certificate of Competency #:� % /6
Contact Phones 340S �f �ena=q a Email Address:
DESIGNER: Architect/Engineer. _--ft—oS£ Pif R991i A 12 hon 0
Value of Work for this Permit: $ - i Fuecw, Square/Linear F�oottaape�6f' Work: )
Type of Work: ❑Addition ❑Alteration ❑New QRepair/Replace ❑Demolition
Description of Work:
Submittal Fee $yy " Permit Fee $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF
CO/CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE
Z 4
64
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC.....
6WNER'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 win) an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to file person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at me job site
for the first inspection which occurs seven (7) days after AdAluilding pennit is issued. In the absence of such posted notice, the
inspection will not be approvea and a rein.spection fee ivjirlie cl rged,
ho
Owner or Agent
The foregoing instrument was acknowledged be/me this _
day of ,20 by
who is personally knout to me or who has produced
As identification and who did lake an oath.
NOTARY PUBLICP
SignatureU
// vv tractor
The foregoing instrumei i was acknowledged before me this_
day of .200 by
�tw who is personally khoawp to� ho has produced��
.A G ZY—i 0 • Y 5side Ri ication and who did,take an oath.
Sign:
Print: .
My Commission Expires:
k#*Rl::k:k#kR#B•#a&:k%#a`f',:xrr,: A:wy: T:gxJ::7:: �:%:>:� sl9:>;/">;:::.*i::R:RXM$I::YY.M�Kyi �YW.MkY:k*Rtp:�fi:%bk�#tF
APPROVED BY ��/ / `� Plans Examiner
Structural Review
Zoning
Clerk
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15109)
Miami Shores Village _ 1
Building Department Zo�a
NpV 1 S
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �--
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 $Y
FBC 20 10
BUILDING Master PermitNo-.1/.� J?_—.2-a5
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION #RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: m_�r /V to /�"4
Occupancy Type: Load: Construction Type:
OWNER: Name (Fee Simple
UiI
City: AMAM
Tenant/Lessee Name:
Email:
0
Address: UJ O
City: AA
Qualifier Name: Ajkm
State Certification or Registration
DESIGNER: Architect/Engineer: _
M
State:
the Building Historically Designated: Yes NO
Value of Work for this Permit: $ E;4! �Squari
Type of Work: ❑. Additi9 ❑ Alteration ❑ New
Description of Work: rg_
LM rnA- Iv>�--w -A4D ¢etf'f�o
44.
Zone: BFE: FFE:
C26 Phone#: i505 Al2
30,5_ 5362, d=
N__ zIp:3J9/_;:5
Phone#: gIJ-5- o?fiPr 2�
of Competency M 1134F5
1 Phone#: 0,54l] Z78-
ige Work: ZiI6-6 t r
pair/Replace /'� ❑ Demolition
Specify color of color thru tile:
Submittal Fee $ rr .. __ Permit Fee $3CD (A _ CCF $ (U . �(� CO/CC $
Scanning Fee $ W Radon Fee $ _ - �� DBPR $ Notary $
Technology Fee $ Training/Education Fee S • (z>0 Double Fee $
Structural Reviews $ Bond $ SLR j�� U
TOTALFEENOWDUE$ 3q0• So
'evised02/24/2014) '
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
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 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.
OWNER or AGENT
The for going instrument was acknowledged before me is
day of it 20 by
G�% who is personally nown to
me or who has produced!- as
identification andZS027EXPI!ES
PURCHAS
NOTARY PUBLIC:ISSION #FF080038
ecember 29. 2017
Print: _4
Seal: f 161,
0
APPROVED BY
Signature
C TRACTOR
The for going instrument was acknowledged before me this
day of IF 20 by
16 £ )IU /iiho is personally own to
me or who has produced l" I-- D L_ as
identification and wzw.
' PURCHAS �//_
NOTARY PUBLIC i10N #FF080(13Aecember 29- 20/ ` iolaryService�coe�
Sign:
Print: Kle_ PL I('P.Y\G. S
t
Seal:
i MV COMMISSION #FF0800, �+S o % MV COMMISSION #FFOA003B
i� EXPIRES December 29. 20+?or n EXPIRES December 29. 2017
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ryS#e ce cym
Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk
I