REV-11-19-2636, 335 NE 101st StMiami Shores Village
Building Department NOV 04 2_0119
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
FBC 20 11
BUILDING
Master Permit No.(ZEkj I�l'
PERMIT APPLICATION
Sub Permit No.1�'
❑BUILDING N-
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
LIP0 MBING ❑ MECHANICAL
❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOBADDRESS: 7;, 7 UE,
161 SIT
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):
\
1FF_,bK (z.1C'G Phone#: �SG )'f 1� !7n I'`_
Address: '�S 1.1T-, �0\
�_i
City: X1 1 Qti( SUc✓R rz<
State: Zip:
Tenant/Lessee Name:
Phone#:
Email: iEDT--tL1Cc,W:C , COr7
CONTRACTOR: Company Name: AA magic a„Ac w! Phone#: 3Os'�ls�"�� � 1
Address: J 13so 6ca Se-y-A.
City: 1�24 tAL�t L State: FL Zip: /
Qualifier Name: AGcti;) Al C—Ou � Phone#:
State Certification or Registration #: C rC J 9 Z tC 'Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address:
City:
hone#:
_State: Zip:
Value of Work for this Permit: $ -1, , a e m — Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace
Description of Work: t_EVJ& IC)o 7 a f rf LE< � m l� C
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ 1 "� CCF $
f? ter:
Scanning Fee $ Radon Fee $ DBPR $
❑ Demolition
Notary $
Technology Fee $ `- t'=k Training/Education Fee $ Double Fee $
Structural Reviews $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
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
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 days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approve n reins ec ion fee will be charged. .
X
Signature Signature
OWNER rAGENT Lt0NTRACTOR
The foregoing instrument was acknowledged before me
me this
da of 20 M by
�,� J who ispersonally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign
Print: •�R�V'a!/,b% Maria Leonor ftm
s,� Commission # GG099300
Seal: = - Expires: April 30, 2021
,, Bonded thru Aaron Notary
as
The foregoing instrument
fw s acknowledged before me this
— day of fC 20 ��j by
Ur '� who is person II own to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
,.�vpIfIIgn,,, Marta Leorror Mljares
Print: =� .�:
Seal: Expires: April 30, 2021
Bonded thru Aaron Notary
APPROVED BY i/�9 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
- - Miami Shores Village F2ECI�:AVED
0 4 4019
N
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:-t3� -
Tel: (305) 795-2204 Fax: (305) 756-8972 C 1 I
INSPECTION LINE PHONE NUMBER: (30S) 762-4949 R
FBC 20
BUILDING Master Permit No-L—
PERMIT APPL ATION Sub Permit No. — (— 0 3
- 2 �
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 3S 1 IO I S-'
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): if-tR} CC V, SSC Phone#: (--'C, `\ ,4eA -7A-2� V'�
Address: S7 N� 10 S-T'
City: w NN \ S State: fir %I— Zip:
Tenant/Lessee Name: Phone#:
Email: 1~1 k-)CQ C— C('"
CONTRACTOR: Company Name: ' fin i [Qj6 &5 �l(�-�-n�C LPL Phone#: 10S— 6"13-0102
Address: 1L o�N � _VJ �,
A ( ^�
City: rlZ(AwC State: �f` Zip:
Qualifier Name:�ff Phone#:��3.Q10Z
State Certification or Registration #: (, L Xs ookoq l� Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ -'t 1, G c a s - `' Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Q- Vis) TC> (2 �(�c_ Rwj C�1�1JG�S
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ I �� ` CCF $ i CO/CC $ �
Scanning Fee $ r ' y Radon Fee $ �- � �T� DBPR $ �- Notary $
Technology Fee $ Training/Education Fee $ t' Double Fee $
Structural Reviews $
Bond $ e:�
(Revised02/24/2014)
TOTAL FEE NOW DUE $ I ;-. - /...,.i
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, certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection whicVang
s ven ) ays after the building permit is issued. In the absence of such posted notice, the
inspection will not be approvreins ect' n fee will be charged.
Signatu
OWNER i6r AGENT
The foregoing -rostrum yg acknowledged before me this
7 day G1� /20 �Cl by
Q( �' who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: �1H Yi?i%�'-
Maria Leorror Wares
Ion
Seal: _ Expires: April 30, 2021
Bonded thru Aaron Notary
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
of day GCl12t� b
/J , 20 ° � Y
Chr �6,041i_ who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
KIM
Print: +'�!r"d!�i.,
/w.tn C--flor'7PfIJQ
Seal:
res
ion # GG099300
Expires: April 30, 2021
Bonded thru Aaron Notary
APPROVED BY�Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)