1160 NE 91 TerrPermit Type (circle):
Miami. Shores Village
V !Lz L Ipuilding Department
aitsio 1 ; 10 50 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2001
Owner's Name (Fee Simple Titleholder) : , ; ,
Owner's Address 1 /
City ,�, �' ', , ' State ,
Tenant/Lessee Name
Contractor's Company Name _, - :_
$ Value of Work For this Permit
Type of Work: ❑., ddition
Describe Work:
(Continued on opposite side)
Electrical Plumbing Mechanical Roofing
4900
❑Alteration
_ ,1
Total Fee Now Due $
Master Permit No.
Zip
Phone # j )( ' / ( .. (. �!
Phone #
Permit No.
Job Address (where the work is being done) f i (- ( • f l , ( 1 '
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO \ \.,
Phone #
Contractor's Address
City State Zip
Qualifier
Architect/Engineer's Name (if applicable) Phone #
Square Footage Of Work: /3 "
* * * * * * * * * * * * * * * * * * * * * * * * * * * F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ + Permit Fee $ / G 0 CCF $ o� cit9 CO /CC
Notary $ '� Training/Education Fee $ a, 80 Technology Fee $ R, 7,-
Scanning $ 6 Radon $ Zoning Bond $ - 3(70 --`
Code Enforcement $ Structural Plan Review. $
)(. ( ) )
❑ Repair/Replace ❑ Demolition
Chc 12/15/03
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of , 20 _, by , day of , 20 , by
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
My Commission Expires: My Commission Expires:
**** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
**************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ***************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
FEB — 2 2004
APPLICATION APPROVED BY: Plans Examiner
Engineer
Zoning
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
Permit Number: Tax Folio Number:
State of Florid
County of
THE UNDERSIGNED hereby give notice that improvements will be made to certain real property, and
in accordance with Chapter 713, Florida Statues. the following information is provided in this Notice
of Commencement.
1. Description of Property: [Legal description of property and street address)
1\U-10 tL) 9/ 7;;/K.
1001-1 -P '-Ser
t'Lv -c A
� d -Lc ,F zO All (01—z i 'LY
2. General Description of Improvem nt:
-1,A 1 4,41( Ii�r�G'�- >4ve� U cc) , 17/
I
n.a
3. Owner(s) Name & Address:
mot( � 0,�
\(1 1V: e )1 `r {rr.
0 errvt't S0r -6 ?sg
Interest in Property:
Uw AN e r
Name and Address of Simple Titleholder: (if other than owner)
4. Contractor Name & Address:
• r e � .,Th
/ c n n v T Vr2,ee L /% r 3b)_3
C /
5. Surety Name & Address: (if any, as per Fl. SSErS .FPIZI `yTh trE d):
HEREBY CE ?TI,' -Y that this is a t u_ ; �;opy of tit
7r,g,n.l tiFcd ap ((++.el�rac on ' t ' ;
n.a
Amount of Bond: $ n.a
6. Lender Name & Address:
n.a
7. Person within the State of Florida designated by Owner upon
may be served as provided by Section 713.13(1)(a)7., Florida
Cn eorg2 CC
loot Lyn/vs ,E �� X37
car �,,t>>L�
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8. In addition to himself, Owner designates the following person[s] to receive a
Notice as provided in Section 713.13(1)(b), Florida Statues
trl ^ge >° )i,>5 �i iC
l v n L 1 f / 3
9. Expiration date of this Notice of Commencement: [the expiration date is 1 year from the date of
recording unless a different date is specified)
Sworn to and subscribed before me this 23 day
of VAyU UAry , 20
Notary Pu
Print Notary's ame:
My Commission Expires: W /° lad A
[seal)
NITNESS my hand and Ofh
'IARVEY RUM, CLERK,
r.
lr�•` McIllssa Lee Biadcweil Prepared by:
r Am. .,'•':missio" °°202639 Address:
Experas April 10. 2007
if/i
Print:
Print:
OR E' k
LAST PAGE
1/-'ZOc 0 v1- S D
,AC20
Signature of Owner(s)
Provide Name Address.
x / kt,x_ CEAOc.O
C 04-0409 re , r9--eW J
PG 4119
and County Courts
m notices or other docu -nts
copy of the Lienor's
tatutes. Provide Name & Address.
I 11111111111111111111111111111111111111111111
TO:
DOCUIffENT COYER PAGE
Brief Legal Description: Of Applicable)
DOCUMENT
TITLE: • NOV( CQ (`) Comoto_nstoAceT
(Warranty Deed, Merepp, Affidavit, ete)
EXECUTED B - �ck,in 'h Le m vl 0
CFN 200480086292
OR Bk 2202B Pss 4118 - 4119► (tags)
RECORDED 02/06/2004 12:45:05
HARVEY RUVIN CLERK OF COURT
MIAMI -DADE COUNTYr FLORIDA
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Owner's Name and Address...
Registered Architect and /or Engineer
Name and address of licensed contractor .. ; - 7(C% 1. .
Location and legal description of lot to be built on:
Lot Block
Street and Number where work is to be done }
State work to be done and purpose of building (by floors) . ~l� � t . � -
"Subdivision.
Date_
No4/C.0 Streetf .
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roo £ hovering
Estimated Total cost of improvements $ Amount of Permit $.. ((Jf
Zone cubage required Plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live Load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks
(Signed)
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the.
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are 277 true //
3
Permit No /_ Date.___( l Read, Sworn to and Subscribed before me.
Disapproved tr __ � _ , Date
Notary Public, State of Florida
( Signed)
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chainnan Member
Member Member
Member ...__ _. Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.