DGT-11-18-3426 Canceled\`\
BUILDING
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 MAR 0 5 20ig
Tel: (305) 795-2204 Fax: (305) 756-8972 (��t� j
INSPECTION LINE PHONE NUMBER: (305) 762-4949 CANCELLED
FB }1�
� Master Permit No. ` L- T `(2) J`t Z(J�)
PERMIT APPLICATION
BUILDING ❑ ELECTRIC ❑ ROOFING
Sub Permit
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
^' CONTRACTOR DRAWINGS
JOB ADDRESS: l � 35 ,V e- 10 C'I-} • f�
City: Miami Shores County: Miami Dade ZIP: 3 3 (3J
Folio/Parcel#:. Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Colnstruction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): C J��T I �OyI R�'r Phone#:
b Address: / 0 3 S y L to e t
City: ��-4 (3(ZC _State: L. ZIP:
Tenant/Lessee
(Name:
Email: ! Icfr4 -
CONTRACTOR: Company Name:
Address,
f6l(At
(9
17
E7 R
L��'i Phone#: �[] /J (��7��
City: C CQ
i /
State:
Yt_ Zip:
B !l
Phone#:
Civalifier Name:
State Certification or Registration #• yc
%
i
r J�cj Certificate of Competency #:
DESIGNER: Ar hit ctt/Engineer•
/
J Phone#: n
c5i Y: State, Zip: �(J
Address:
Value of Work for this Permit: $
0 O
Square/Linear Footage of Work:
Type of Work: ElAddition❑
Alteration
❑New ❑ Repair/Replace �❑ DemolitionDescription
fipo
of Work: (/%
# J�
fx)
yzp- 1DA?P1 / to /"•- �� `��
Specify color of color thru tile:
Submittal Fee $_
Scanning Fee $ _
Technology Fee $_
Structural Reviews
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Rev1sed02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
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 on 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 issue In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. N, M AA
Signatu
OWNER or AGENT
CONTRACTOR
n inst m�en�t was acknowledged before me this The foregoing Instrume t was acknowledged before
me this
day of / `1 Ar R iCA 20 � by � day of 20 r by
who is personally known to
me or who has produce (/� � V V1)0if L
identification and who did take an oath.
NOTARY PUBLIC:
/NoTi ry Public State of Florida
Sign: t*: Jo eRousseau
ammxss�oo a 193011
Expi s OS/042022
Print:
Seal:
who is personally known to
me or who has produced A as
identification and who did to e a oath
NOTARY PUBLIC:
Sign:
DhYq AaYk BNtr ofPYrW
Print:
Seal:
APPROVED BY 1� Plans Examiner Zoning
a Iti Structural Review Clerk
(Revised02/24/2014)
�.
�.. .
l�fr':�(r'tio`t`IY��C`�".''tY<��Y`(`t :cK`t�n[K'CK'C�nf��rR .. :�t�z. i :�.�t.
8'cl�tHi'i'1u72afd 2ildp`! �sfG3R ,�"'' � '� , ; �r�,t• � . ,: t ., ::, , _. ; •,, t,
4.• r.}.�'yJ }1'.R��. ►Aim T.L.�JJJ.>J }J�tT
Miami Shores Village RECEIVED
Building Department wv 16 2020
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 FBC 20
BUILDING
Master Permit No.1)a-T—f18 3� zlP
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL
❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
('2,/ � ^' n
O 6`3, : I� � o Vp+
JOBADDRESS:Ok
J f
City: Miami Shores
County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes NO
Occupancy Type: Load:
Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):
�� I V� �S C--°�-�� e(7 1 Phone#: ' 7
Address:
City: �/�1,1�-- � o�
\ State::j2a Zip: 2 2 1,�3R� 1
Tenant/Lessee Name:
�PPhhone#:
Email:
CONTRACTOR: Company Name:
Phone#:
Address:
City:
State: Zip:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Cal%Wf'&
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
CCF $ CO/CC $
DBPR $ Notary:
Double Fee $ .
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
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.
R or AGENT
The foregoing instru en was acknowledged before me this
day of r 20 2 M by
..
G. r6x9a 509� %dlt Qo is personally known to
me or who has produced FL DJ-- as
identification and who did take an oath.
NOTARY PUBLIC:
Print
Seal: ::'r'.. SELENA ARANDA
"a MYCOMMISSIOt=G971705
EXPIRES: March 22, 2024
p<
'•:;;oen,°� Bonded Th'u Notary Pub4c llndelYlMBI9
######### #
APPROVED BY
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20 by
. who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Plans Examiner
Structural Review
as
Clerk
(Revised02/24/2014)
fin/