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DS-6-16-1610, 760 NE 96th StyHUR£S G <ORIDp' Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit No. DS-6-16-1610 Permit Type: Driveways/Sidewalks/Slabs Per it Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 6/21/2016 1 Expiration: 2/1 /2 a1 Project Address Parcel Number Applicant 760 NE 96 Street 1132060142080 Miami Shores, FL 33138- Block: Lot: JUSTIN & GIANNINA LEWIS Owner Information Address Phone Cell JUSTIN & GIANNINA LEWIS 760 NE 96 Street (786)586-2346 MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone HOME OWNER In Review Comments: Date Approved:: In Review Date Denied: Type of Work: REMOVE ASPHALT DRIVEWAY AND INST Additional Info: Bond Return : Classification: Residential Scanning: 3 Fees Due Amount Bond Type - Owners Bond $500.00 CCF $1.20 DBPR Fee $2.25 DCA Fee $2.25 Education Surcharge $0.40 Permit Fee $150.00 Scanning Fee $M0 Technology Fee $1.60 Total: $666.70 Valuation: $ 1,779 00 Total Sq Feet: 1186 Pay Date Pay Type Amt Paid Amt Due Invoice # DS-6-16-60137 06/09/2016 Check #: 157 $ 50.00 $ 616.70 06/21/2016 Credit Card $ 616.70 $ 0.00 Bond #: 3118 Avanaoie ins Inspection Type: Final Foundation Review Planning Review Building In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I'certifyermorthat _all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction aXL e+�ir1 . u e, I authorize the above -named contractor to do the work stated. June 21, 2016 Authorized Signature: Owner / Applicant / Contractor / Agent i Buildkig Department Copy June 21, 2016 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 iiil'ijilll((liiii((IIf'` li 1i Ih:l Iltll 1j±I I lllii iljl ljrl ,OR, B . 31_1121 P, -" Ps , h: L. CORDED i1r�/._!/?i ,^1;_I:;?_`-02 HARVEY RUVIN? i_LERP;. OF COUR! i'i].H111-L!riUt �.�'��ii! F 9 tl_J�R].UH COVENANT OF CONSTRUCTIO14 WITHIN,RIGHT OF WAY Whereas, (owner) ? 7 ; _ Z�, < hereinafter referred to as the owner of the f9fl-awing described property (address): 2&o d �_ Flo Legal Description: LoM ,djS Block lob Subdivision __V, g ., 56:, ?2 ,X;6 /p- 3 Folio # /r-; L) ;& Requests permission to install (describe work): h�,„ Within the public right of way of (address) o 3/�� IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows: 1. To maintain and repair, when necessary, the above -mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. 2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and 'effect and be binding on the undersigned, their heirs and assigns, until such time as this obligations has been canceled by an affidavit filed in the Public Records of Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorjved representative). ?osPwYfP sty: C,11A-SE A. LALrANI Signature ! MY COMMISSION #FF075730 Owner or Agent '�`�;�FF�eo-�` �x�ir��s Mann 3,, 2018 §�=ti163 FloridiNolar/ScNlce.com State of to 'da County iami Dade T for goin ins rument was acknowledged before me this 2/ day of �''`�' , 20 �� , by v+s7h . who is personally known to me or who has produced )-O-Z> -- identification. NOTARY PUBLI Sign: Print: <y smT OF KORIVA, COWTY g e`e Cl[Ri odgimd Bled in- yoffim wa �I -y of � V/ .LEI WITNESS my rend and O89pal Sea'. e HARVEY RUVIN, miml and Qwny C&Ms V_ `°° WE FK D.C. �Q`cr►1Nr! Miami Shores Village BUILDING PERMIT APPLICATION 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 JUN 0 g 2016 ' �_ ----_ FBC 20 Master Permit No. Q,516 — %6f07 Sub Permit No. ❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: �/ ((?C� �J 4 -- tJ/ City: Miami Shores County: Miami Dade Zip: '3 31—?2 Folio Parcel#: J�32 �j —0/ / " I / 6 ncO Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):_{®/LcS /ice. 4-GcI/ S Phone#:./LJ Address:, City: Tenant/Lessee Name: Email: av State: %�� Zip: CONTRACTOR: Company Name: ��Lv�` Phone#: Address: City: State: Qualifier Name: State Certification or Registration #: DESIGNER: Architect/Engineer: one#: Certificate of Competency #: one#: Zip: Address: City: State: Zip: Value of Work for this Permit: $ l W Square/Linear ; Footage of Work: Type of Work: ❑ Addition ❑ Alteration //� ff ❑ NNew � rcepair/Replace ❑ Demolition Description of Work: ✓/-�it�i3�t� l olta,( / J, y+/uG � f�tl,C rie�rrire / Specify color of color thru the:'1.6L4_ Submittal Fee $ � ' Permit Fee $ �5 CAD $ 2- � CO/CC $ Scanning Fee $ C�(3 Radon Fee $ ` 1c:; DBPR $ Notary $ Q Technology Fee $ 6d Training/Education Fee $ C O Double Fee $ 0 Structural Reviews $ Bond $ r_:m I GO TOTAL FEE NOW DUE $ ( b (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 ccurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approv/and a reinspection fee will be charged. Signatu OWNER or AGENT Signatu CONTRACTOR The for goin instrument was acknowledged before me this The foregoing instrument was acknowledged before me this AVday of 20 by day of 20, by J( �A/ 1 Lent�is'- , who is personally known to who is personally known to me or who has produced 12 as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: Seal:y���, Notary P:rvblic State of Florida Seal: Joanna1 Feliciano v o� My Comission FF 082753 ?or no°' Expires 1/12/2018 APPROVED BY Plans Examiner r [% Zoning Structural Review (Revised02/24/2014) Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME: r >�iS �Lr_ %� i. DATE: ADDRESS: �/ 20 Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one -family or two-family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with -holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. 1 understand that state law requires construction to be done by a licensed contractor and have applied for an owner -builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. Initial 2. 1 understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial 3. 1 understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts. Initial 4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or substantially improved it for sale or lease, which ,'olates the exemption. Initial- 5. 1 understand that, as the owner -builder, I must provide direct, onsite supervision of the construction. Initial 6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. Initial I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner -builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner -builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner -builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial 8. 1 understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial C(/S/ I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govern owner -builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. Initial_g 10. 1 understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or http://www.mVfloridalicense.com/dbpr/pro/cilb/index.html Initial_ 11. 1 am aware of, and consent to; an owner -builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: Initial__��_ 12. 1 agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure. Initial Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner -builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this day of 73-0,e7 & , 20 / f By :Yi) who was personally known to me or who has Produced thereAicense or %�— as identification. OWNER O JUN o q ZM • Y • • CERTIFIED TO: 7' PARK WA Y F. L P. NO /D. f >2.7C' �a 0 h T, N LOT-6 p BLOCK - 68 p OA O � 0 0 Z RAPID TITLE SERVICES COMPANY, OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY, JUSTIN R. LEWIS AND GIANNINA LEWIS, BANK OF AMERICA, NA., ITS SUCCESSORS AND/OR ASSIGNS AS THEIR INTERESTS MAY APPEAR z1 2.512 Q 2 U viLOT-5 BLOCK - 68 `.CONC. SIDEWAL ``>i , 00' FI.P. %z' BLOCK .' 0 ID. CORNER I. Ga 0 3.9 N r. u, 0 • o v J X3' A/C AL UMINC SHED CONC. REMAINDER 0 OUL 3 LOT - 4 vj BLOCK - 68 m WEST 112 OF LOT-4 6' WOOD BLOCK - 68 FENCE t FLOOD ZONE: X PROPERTY OF: JUSTIN R. LEWIS AND GIANNINA MAP & PANEL= 12086CO306 LEWIS COMMUNITY No.: 120652 SUFFIX L 760 N.E. 96th STREET, DATE OF FIRM: 09-11-2009 MIAMI SHORES, FLORIDA 33138 BASE ELEV. = N/A .f w LOCATION SKETCH NOT TO SCALE 74- 10 4N Y / TAl LEGAL DESCRIPTION• x'�' (yZ`�HE WEST 11'2 OF LOT 4 AND ALL OF LOT 5, BLOCK 68, 'MIAMI SHORES SECTION NO. 3'; ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 10, PA� 37, OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA. C!JlVRVEYOR'SN0TES: NOT VALID UNLESS SIGNATURE IS EMBOSSED WITH THE REGISTERED LAND SURVEYOR'S SEAL ��jGf Lr�t 1 ✓ )LEGAL DESCRIPTION PROVIDED BY OTHERS. PROPERTIES SHOWN HEREON WERE NOT ABSTRACTED FOR EASEMENTS OR OTHER RECORDED EN ,�UMBRANCES NOT SHOWN ON THE PROPERTY PLAT OF RECORD. MEASUREMENTS TO WOOD FENCES ARE TO OUTSIDE OF WOOD. • • • s 5) UNDERGROUND UTILITIES, FOUNDATIONS, OR OTHER IMPRC;V�'I1PN:-S, IF Z'a 19RE NOT • • • . • • • _ LOCATED. • • •00000 • • 6)1 EVATIONS, IF SHOWN ARE BASED ON NATIONAL GEODETIGVERTIG9� AL DATiIM 19. • • • • • • / ✓ ./L Cam• �/ G 17�FENCE OWNERSHIP NOT DETERMINED UNLESS OTHERWISE �jQjE,q • • • c 8) MEASUREMENTS TO WIRE FENCES ARE TO CENTER OF WIRE. • •• •• •••• •••••• 9) WALL MEASUREMENTS ARE TO/FROM FACE OF WALL. • • • • • 10) DRAWING DISTANCE BETWEEN WALLS AND/OR FENCES AND•r'mPtATY LINES haleBE • ' • a • EXAGGERATED FOR CLARITY. as** • • • • • • • • • • F 11) FLOOD ZONE INFORMATION WAS DERIVED FROM FEDERAL EX1 fj?, jACY MAf fAQW E*NT AGF•NCY • FLOOD INFORMATION RATE MAPS • • • • •• • 12) BEARINGS IF ANY SHOWN ARE BASED ON ASSUMED MERIDIAN ATo CENTERLINE N.E. 96th STREET = •••••• ••• EAST • : ••••:• LEGEND LC.V. IRRIGATIONCONTROL VALVE P.C.P. PERMANENT CONTROL POINT Wlly •WATER Mj �2• • • • • • A/C AIR CONDITIONER I.P. IRON PIPE PLS PROFESSIONAL LAND SURVEYOR WV WATERYALVE • AVE AVENUE FPL FLORIDA POWER& LIGHT PSM PROFESSIONAL SURVEYOR AND MAPPER W.U.P. WOODU7W-fT4'POLE BLVD. BOULEVARD ELF FOUND IRON PIPE PL PROPERTYLINE BM BENCHMARK F I.R. FOUND IRON ROD P.O.B. POINT OF BEGINNING CA TV CABLE TELEVISION BOX FND. FOUND P.O.C. POINTOFCOMMENCEMENT C.B. CATCHBASIN L ARCLENGTH P.R.C. POINT OF REVERSE CURVATURE SYMBOLS CBS CONCRETE BLOCK STRUCTURE (L) LEGAL P.R.M. PERMANENTREFERENCE MONUMENT .--- ._-- CONCRETE CHB CHORD BEARING L.P. LIGHTPOLE PT POINT OFTANGENCY OVERHEAD UTILITY LINES CH CHORD DISTANCE LB LICENSED BUSINESS R RADIUS WIRE FENCE CDR CORNER LS LAND SURVEYOR (R) RECORD WOOD FENCE CT COURT (M) MEASURED R.E. RIMELEVATION PROPERTY CORNER q CENTERLINE NA VD NORTH AMERICAN VERTICAL DATUM R/W RIGHT-OF-WAY WATER FLOW CL. CLEAR NGVD NATIONAL GEODETIC VERTICAL DATUM SAN SANITARY 9.60 EXISTING GRADE ELEVATION CONC. CONCRETE NO ID. NOT IDEMIF14BLE S.I.P. SET IRON PIPE PROPOSED GRADE ELEVATION C.O. CLEAN OUT NO. NUMBER S.I.R. SET IRON ROD N WATER VALVE E.B. ELECTRIC BOX NTS NOT TO SCALE ST. STREET 4 SIGN ELEV. ELEVATION O.R.B OFFICIAL RECORD BOOK T TANGENT DRAINAGE MANHOLE ENCR. ENCROACHMENT ON/PL ON PROPERTY LINE TB.M TEMPORARYBENCHMARK SANITARYMANHOLE ER.P. EL EVA TION REFERENCE POIN T DUL OVERHEADUTILITYLINES TEL. TELEPHONE IK FIRE HYDRANT F.F. FINISH FLOOR P.C. POINT OF CURVATURE TYP. TYPICAL {'} LIGHTING FIXTURE F.H. FIRE HYDRANT P.C.C. POINT OF COMPOUND CURVATURE UE UTILITYEASEMENT L7 FIRE DEPARMENT CONNECTION A BOUNDARY SURVEY I HEREBY CERTIFY THAT THIS BOUNDARY SURVEY WAS MADE UNDER MY SUPERVISION AND MEETS STANDARDS OF PRACTICE SET FORTH BY THE FLORIDA BOARD OF PROFESSIONAL SURVEYORS AND MAPPERS IN CHAPTER 5J-17.050 THROUGH 5J-17.052, NOT VALID WITHOUT THE SIGNATURE AND THE FLORIDA ADMINISTRATIVE CODE, PURSUANT TO ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SECTION 472.027, FLORIDA STATUTES, AND, THAT THE SURVEYOR AND MAPPER. SKETCH HEREON IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. SUBJECT TO NOTES AND -TIONS SHOWN HE ON. SAMUEL I I CHBEIN FLORIDA PROFESSIONAL SURVEYOR AND MAPPER REGISTRATION NO. 3587. DATER 11131201 PROFESSIONAL SURVEYING AND MAPPING LANNES & %-0/_1 , INC. LB # 2098 FRANCISCO F. FAJARDO PSM # 4767 (QUALIFIER) 385 ALHAMBRA CIRCLE - SUITE C, CORAL GABLES, FLORIDA 33134 PH (305) 666-7909 FAX (305) 442-2530 SCALE: 1" = 30' I DRAWN BY: JONELLE I DWG. No.: 258831 Miami Shores Village 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 BUILDING PERMIT APPLICATION UILDING ELECTRIC ❑ ROOFING F? T!V�] DEC2 1 2016 BY. FBC 2//0__ j' Master Permit No.p';- —' 1 1161 Sub Permit No. ❑ REVISION EXTENSION RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CONTRACTOR JOB ADDRESS: -? & C , CANCELLATION ❑ SHOP DRAWINGS /3 Folio/Parcel#: I 3 �t-(9 &C)/ 4f ,107V Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder): L2 r01 Phone#: / 767 ,'Mo -23,�' 16 Address: City: �Uz4tu State: l Zip: ,l Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: �(�L'�-2�� 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: $ /I? S Square/LinearrF�F000t�tage of Work: Type of Work: El Addition ❑ Alteration El New [ epair/Replace ❑ Demolition Description of Work: sh.. — ,fs-cam_ 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 $ 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 (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 OWNER or AGENT The oregoin instrument was acknowledged before me this day of D C�20 ` (, by Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of 20 by 17 who is personally known to who is personally known to me or who has produced (4 )ZKS me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign:4* Sign: Print: Print: MAHARAI K. GONZALEZ Seal: '" "`' Seal: +e y ? MY COMMISSION # GG 044602 =,• :a = EXPIRES: November 2, 2020 Bonded Thru Notary Public Underwriters APPROVED BY Plans Examiner Zoning • g Structural Review Clerk (Revised02/24/2014) 12/21/16 To whom it may concern, Parcel #: 11320601420 Regarding Permit #: DS-6-16-1610 Owner: Justin R. Lewis Address: 760 NE 961h St Miami Shores, FI 33138 I am writing to request an extension for inspection as there are a few remaining details to take care of because my time as owner / contractor has been limited due to an increase in my own business. Time has passed very quickly. be4'ofC mr- fir oz 2 � d atA ©V DC 201(o L�c.� JUSt k n �o 's �Uj f r o s PCOdeuer-c� FlCri da Jr i cY t icers c Os i Z- =27 - LEZ GG 044602 * *'ber 2, 2020 '•',;eop��o lic Underwriters