FW-6-16-1611, 760 NE 96 St�swOREr i,� Miami Shores Village
10050 N.E. 2nd Avenue NE
F w . ..... Miami Shores, FL 33138-0000
Phone: (305)795-2204
<0RI10A
Permit No. FW-6-16-1611
Permit Type: Fence/Wall
Permit Work Classification: lron/Ornamental
Permit Status: APPROVED
Contractor(s) Phone Cell Phone
HOME OWNER
Approved:
Comments:
Date Approved:
Date Denied:
Type of Construction: Other
Classification: Residential
Fees Due
Amount
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee - Wire & Wood
$100.00
Scanning Fee
$9.00
Technology Fee
$0.80
Total:
$114.60
issue Date: 6/21/2016 1 Expiration: /201
Valuation: $ 500.00
Total Scl Feet: 22
Additional Info: ADD A 6' HIGH ALUMINUM FENCE A I
Scanning: 3
Pay Date Pay Type Amt Paid Amt Due
Invoice # FW-6-16-60138
06/09/2016 Check #: 157 $ 50.00 $ 64.60
06/21/2016 Credit Card $ 64.60 $ 0.00
Available Inspections:
Inspection Type:
Final
Foundation
Review Building
Review Building
Review Planning
Review Planning
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 ELECTRICAyI, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVI �t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction o ing. Futhermore, I authorize the above -named contractor to do the work stated.
June 21, 2016
Authorized Signature: Owner / Applicant
Buil ing Department Copy
June 21, 2016
/ Contractor / Agent
1
Miami Shores Village !��cJ� ;j�
_AAA S Building Department JUN092016
10050 N.E.2nd Avenue, Miami Shores, Florida 33138�:
Tel: (305) 795-2204 Fax: (305) 756-8972
(�I A INSPECTION LINE PHONE NUMBER: (305) 762-4949
li FBC 201Y
BUILDING Master Permit No. 10PW A ` 46
PERMIT APPLICATION Sub Permit No.
R� UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [::]RENEWAL❑\PLUMBING ❑ MECHANICAL OPUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION SHOP
/ CONTRACTOR DRAWINGS
JOB ADDRESS: 7&0 J�IG�=CfCy �J�
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: // ^ "3,;z 0/'V—a20go Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): y�,�_ %� . Li'S Phone#:_�c�
Address: Mv r)
City: i.i�`� DJ State: Zip:
Tenant/Lessee Name: Phone#:
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: $app _ „��� Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteratio�a`. � New ❑ Repair/Replace ❑ Demolition
De cr' tion of Work: T !`i 'a _ri�cy�
r � �
Specify color of color thru tile:
Submittal Fee $ S Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $_
Technology Fee $ 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 (7) days after the building permit is issued. in the absence of such posted notice, the
inspection will not be appOved and a reinspection fee will be charged.
Signatu
OWNER or AGENT
The f"rego' g instrument was acknowledged before me this
day of _ )wI 20 , by
who is personally known to
me or who has produced C as
identification and who did take an oath.
NOTARY PUBLIC:
Sign
Seal: =ore °��^ Notary Public State of Florida
• Joanna M Feliciano
v 04 My Commission FF 082753
,'FcincP ExVires01/12/2ols
***************
APPROVED BY
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of
me or who has produced
20 , by
who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
as
Plans Examiner Zoning
(Revised02/24/2014)
Structural Review
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: z2 • LJc li S DATE: �� 9-167
ADDRESS: �� /lo�� /sue-; 2P14-� Zv/ ✓/���
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 tracts.
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; wh ch violates 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 unty or municipal ordinance.
Initial
7. 1 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
9. 1 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
_./
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.myfloridalicense.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. r---r
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 20 1,6
L M
- v
ZetAp
known has
O t-
u' w
m U N
By`) )S 1Y7
who was personally to me or who
�SEo
C OQJ
Produced the License or
�as identification.
; Ta'
'
Z `� W
JP.
a° P 0k.
OWNER
ARY
► t"-`
v
%'dam 5 - /0
`J��e�v`, f,��L ►1 �2
JUN Y 7 2016
06-09-16
SUN ®9 2016
Fence Details for 760 NE 961t' St Miami Shores, FI 33138
Owner Justin R. Lewis
Install 2 swing gates on both sides of property located on survey. Gates will be 6' high al minum white
powder coat. They will open in towards the house.
Fences Good Side Out. The vertical and horizontal
supporting members of a fence shall face the _ ^/%Iv/�"�✓
interior of the plot on which the fence is located p(
and the finished side shall face the adjoining
lot or any abutting rig"it-of-way.
o ❑op��
Fences Good Side O ofha fencee vertica) shall to a the
supporting memberc
interior of the plot on which the fence i locate
and the finished sic shall face the adjoining
lot or any abutting ri ht-of-way.
•• ... : : •
• • ..
FE�I s U*)od Side Out. The vertical and horizontal
64-4)rt!g members of a fence shall face the
interior of the plot on which the fence is located
and t% fink.' ed side shall face the adjoining
• ••. ••• •llV or ,n�;ar:ut%ing right-of-way.
• • • • • • i 0 �i`•-0-0
• • • 000
•
•• •
•
• • • • • • • • • •
Ift
"A' &t
�3
LOCATION SKETCH
F. I. P.
NO ID.
ca
W
0
0
0
of
0
0
y
0 f0'
LOT-6
BLOCK - 68
horizontal I
Fences Good Side Out. The vertwal and
r�tembers of a fence shall face the
supporting which the fence is located
lot on adjoining
interior of the0
and the finished sidert of Tway e the
lot or any abutting g
CERTIFIED TO:
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 MAYAPPEAR
FLOOD ZONE: X • • • • • +P•RORERTY OF: JUSTIN R. LEWIS AND GIANNINA
MAP & PANEL= 1208 0306: L�l�kS
COMMUNITY No.: 120 . 2 .• • • • •
SUFFIX.' L 760 "E.06th STREET,
DATE OF FIRM: 09-11-200 •• • MIA;b 4WORES, FLORIDA 33138
BASE ELEV.= N/A •• •' •
•
BLOCK
CORNER
REMAINDER OF
LOT-4
BLOCK - 68
Q
LEGAL DESCRIPTION:
THE WEST 112 OF LOT 4 AND ALL OF LOT 5, BLOCK 68, 'MIAMI SHORES SECTION
NO. 3" ACCORDING TO THE PLAT THEREOFAS RECORDED IN PLAT BOOK 10,
PAGE 37, OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA.
SURVEYOR'S NOTES:
p 1) NOT VALID UNLESS SIGNATURE IS EMBOSSED WITH THE REGISTERED LAND SURVEYOR'S SEAL.
2) LEGAL DESCRIPTION PROVIDED BY OTHERS.
3) PROPERTIES SHOWN HEREON WERE NOT ABSTRACTED FOR EASEMENTS OR OTHER RECORDED
ENCUMBRANCES NOT SHOWN ON THE PROPERTY PLAT OF RECORD.
4) MEASUREMENTS TO WOOD FENCES ARE TO OUTSIDE OF WOOD.
5) UNDERGROUND UTILITIES, FOUNDATIONS, OR OTHER IMPROVEMENTS, IF ANY, WERE NOT
LOCATED.
6) ELEVATIONS, IF SHOWN ARE BASED ON NATIONAL GEODETIC VERTICAL DATUM 1929.
7) FENCE OWNERSHIP NOT DETERMINED UNLESS OTHERWISE NOTED.
Fences Gnpr' Side Out. The vertical and horizontal ! 8) MEASUREMENTS TO WIRE FENCES ARE TO CENTER OF WIRE.
supporill`,l 1116rnbers of a fence shall face the I 9) WALL MEASUREMENTS ARE TO/FROMFACE OFWALL.
Interior J1 he ;lot on which the fence is locate' fib DRAWING
ERATDISTANCE
FOR B TY.EENWALLS AND/OR FENCES AND PROPERTY LINES MAYBE
and th3 ijnished side shall face the adjoiningi 11)FLOODZONE INFORMATION WAS DERIVED FROM FEDERAL EMERGENCY MANAGEMENT AGENCY
lot or ai 1 y at,L;tting right-of-way. 1 FLOOD INFORMATION RATE MAPS
12) BEARINGS IF ANY SHOWN ARE BASED ON ASSUMED MERIDIAN AT: CENTERLINE N.E. 96th STREET =
--Y EAST
LEGEND I.C.V. IRRIGATIONCONTROL VALVE P.C.P. PERMANENT CONTROL POINT WIM WATER METER
A/C AIR CONDITIONER LP. IRON PIPE PLS PROFESSIONAL LAND SURVEYOR W V WATER VALVE
AVE. AVENUE FPL FLORIDA POWER 8 LIGHT PSM PROFESSIONAL SURVEYOR AND MAPPER W U.P. WOOD UTILITY POLE
BLVD. BOULEVARD FLP. FOUND IRON PIPE PL PROPERTYLINE
BM BENCH MARK FIR. FOUND IRON ROD P.O.B. POINT OF BEGINNING
CA TV CABLE TELEVISION BOX FND. FOUND P.O.C. POINTOFCOMMENCEMENT
C.B. CATCH BASIN L ARCLENGIi/ P.R.C. POINT OF REVERSE CURVATURE SYMBOLS
CBS CONCRETE BLOCK STRUCTURE (L) LEGAL P.R.M. PERMANENTREFERENCE MONUMENT -_.-6 CONCRETE
CHB CHORD BEARING L.P. LIGHT POLE P. I. POINT OF TANGENCY ----- OVERHEAD UTILITY LINES
CH CHORD DISTANCE LB LICENSEDBUSINESS R RADIUS`- WIRE FENCE
CDR CORNER LS LAND SURVEYOR (R) RECORD n WOOD FENCE
CT COURT (M) MEASURED R.E. RIMELEVATION PROPERTY CORNER
fL CENTERLINE NAVD NORTHAMERICAN VERTICAL DATUM RAN RIGHT-OF-WAY WATER FLOW
CL. CLEAR NGVD NATIONAL GEODETIC VERTICAL DATUM SAN. SANITARY 9__60 EXISTING GRADE ELEVATION
CONC. CONCRETE NO ID. NOT IDENTIFIABLE S.I.P. SET IRON PIPE --M PROPOSED GRADE ELEVATION
C.O. CLEAN OUT NO. NUMBER S.LR. SET IRON ROD l4 WATER VALVE
E B. ELECTRIC BOX NTS NOT TO SCALE ST. STREET SIGN
ELEV. ELEVATION O.R.B OFFICIAL RECORD BOOK T TANGENT DRAINAGE MANHOLE
ENCR. ENCROACHMENT ON/PL ON PROPERTY LINE TB.M TEMPORARYBENCHMARK SANITARYMANHOLE
E.R.P. ELEVATION REFERENCE POINT O.UL OVERHEAD UTILITY LINES TEL. TELEPHONE 1K FIRE HYDRANT
FF FINISHFLOOR P.C. POINT OF CURVATURE TYP. TYPICAL 0 LIGHTING FIXTURE
F.H. FIRE HYDRANT P.C.C. POINTOF COMPOUND CURVATURE U.E. UTILITYEASEMENT t7 FIRE DEPARMENT CONNECTION
A BOUNDARY SURVEY
-- =__� PROFESSIONAL SURVEYING AND MAPPING
I HEREBY CERTIFY THAT THIS BOUNDARY SURVEY == -` - _ - "_
WAS MADE UNDER MY SUPERVISION AND MEETS_ r LA NNES &GAR CIA INC.
STANDARDS OF PRACTICE SET FORTH BY THE �_" J r - 7
FLORIDA BOARD OF PROFESSIONAL SURVEYORS AND n° LB # 2098
MAPPERS IN CHAPTER 5J-17.050 THROUGH 5J-17.052, rcia
NOT VALID WITHOUT THE SIGNATURE AND THE FLORIDA ADMINISTRATIVE CODE, PURSUANT TO a FRANCISCO F. FAJARDO PSM IT 4 767 (QUALIFIER)
JRIGINAL RAISED SEAL OF A FLORIDA LICENSED SECTION 472.027, FLORIDA STATUTES, AND, THAT THE a^n65
SURVEYOR AND MAPPER. SKETCH HEREON IS TRUE AND CORRECT TO THE 385 ALHAMBRA CIRCLE - SUITE C,
BEST OF MY KNOWLEDGE AND BELIEF. SUBJECT TO CORAL GABLES, FLORIDA 33134
NOTES AND #ONS SHOWN HE N. PH (305) 666-7909 FAX (305) 442-2530
SAMUEL I CHBEIN
FLORIDA PROFESSIONAL SURVEYOR AND MAPPER [FTIL7DDATE:11/13/2015 SCALE: 1 " = 30' DRAWN BY.• JONELLE DWG. No.: 258831
REGISTRATION NO. 3587
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
9 ILDING ❑ ELECTRIC ❑ ROOFING
DEC 2 1 2016
3Y__ ram► AI
F BC 20 /
Master Permit No. 1 lj "6 16—�6f
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
_?
Inn nnnnrcc.
City: Miami Shores County: Miami Dade Zip: �7
Folio/Parcel#:_/ 3y'S 0tlo o'1 Lj d x Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: // FFE::
OWNER: Name Fee Simple Titleholder): 4. > . uu Phone#:
Address: ,
City: `
Tenant/Lessee Name:
Email:
State:
Phone#:
CONTRACTOR: Company Name: t.L..tti Phone#:
Address:
City: State:
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 QR-epair/Replace ❑ Demolition
Description of Work:
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 opproyed and a reinspection fee will be charged.
Signature
j OWNER or AGENT
The foregoin Instrument was acknowledged before me this
ay of �bcc 120 by
Signatu
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of
\l_?25TI I 1 Fj',I) "--)who is personally known to
me or who has produced ;mil \ 4y)\w me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
20 by
who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
*; MY COMMISSION # GG 044602 S I
Seal: a; EXPIRE S: November2, 2020
L
;°P' Bonded Thru Notar
y Public Underwriters
as
***************************** **** ***********************************************************************
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
12/21/16
To whom it may concern,
Parcel #: 11320601420
Regarding Permit #: FW-6-16-1611
Owner: Justin R. Lewis
Address: 760 NE 96i11 St Miami Shores, Fl 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.
ire c;i►� was Qc��naw�jocd be r-or� rr�e s
�a5 P eed C'lOrt ciG dar ���5 I `C�t
q44� 1
•�'pr a MAHARAI K. GONZALEZ
= My COMMISSION # GG 044602
3r !.
EXPIRES: November 2.2020
,Fof Fro,. Bonded Thru Notary Public Underwriters