RC-07-2014BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type (circle):
Owner's Name (Fee Simple Titleholder)
Owner's Address \-
City
�tB
Tenant/Lessee Name
tate
Miami Shores Village
Building Department
10050.N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 95.2 04 Fax: (305) 756.8972 2
Roofing
Master Permit No.
Phone # 9 . L\
Zip k
Phone #
SEP 2 2U07
BY:P
Permit No. QC 0 — 20 1 4
Job Address (where the work is being done) I A) C)\
City Miami Shores Village County Miami -Dade Zip O
FOLIO / PARCEL #
Is Building Historically Designated
Contractor's Company Name Ow
State Certificate or Registration No.
Type of Work: DAddition
Describe Work: )t
NO
Phone #
Contractor's Address (( V
City State Zip
Qualifier Name 4 , / Phone #
to of Competency No.
Architect/Engineer's Name (if applicable} Phone #
Value of Work For this Permit $ .3,gco .3,g oo Square / Linear Footage Of Work:
DAlteration ❑NewRepair/Replace emolition
* * * * * * * * * * * * * * * * ** * *.* ** ** * ** * * * *** *** *F six** **** *** **** **** *** * * * **** * *** * * * *** * * * ***
/4)510- i 0 Submittal Fee $ Permit ee $ a�
Notary $ Training/Education Fee $ 1 60
Scanning $ CO • Radon $
Bond $ Code Enforcement $
Structural Review. $ T o ee Now Due $
2 i s : NOV 0 6 2007 L =` See Reverse side --
1 + - D ►u-1 w \ A i i Al
2_ ,A?„o,Q, — MIAMI SHORES VILLAGE
DPBR $
CCF $ 2 .40 CO /CC
Technology Fee $
Zoning $
6Q2 -qJ
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 CONDMONERS, 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 ( N ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a bu`i D err tit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencem i (614 onstruction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy o 6o141ed notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the builds %fiit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
` p i a! —��
Sign .T0 in Signature �)
Owne7 gent
The for going instrument was acknowledged before me this
day of `it?�i t s 20 n by Ica IOt
(Revised 07/10/07)
APPLICATION APPROVED BY:
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
The foregoing instrument was acknowledged before me this
day of
Contractor
, 20 _ , by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign: _
Print: . ,' r ''''''' t Sujellys Calvo
i ° . :. s COMMISSION #DD662643
My Commission Exp4-$ ' G,,,
� ^�
'P EXPIRES: APR. 12, 2011
* * *** x+r*a:*********** *gy►NsAIVISWERld sash* * ** x***a:**** *** *** +***** : ******,x**:*** *** ** : *** * * *** *** ** ****** ****
Sign:
Print:
My Commission Expires:
/ 0A 9/r,
Plans Examiner
Engineer
Zoning
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: Electrical
Owner's Name (Fee Simple Titleholder) 5)Ct, kter. Phone #
Owner's Address ►�
City \ \ S� State
Tenant/Lessee Name
E -MAIL:
City Miami Shores Village wit
FOLIO / PARCEL #
Job Address (where the work is being done)
Is Building Historically Designated YES
Contractor's Company Name J y 4/Z» 7 T�G�
Contractor's Address /4/ 6 7
City ` /0177 / State .�
Qualifier Name icar)Gf5GO /2 4,6 .7 U5
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $ U00 �"
Submittal Fee $
Permit Fee $
Bond $ Code Enforcement
Structural Review. $
Miami Shores Village Fear
Building Department Et OCT 0 4 20H7
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 By. Tel: (305) 795.2204 Fax: (305) 756.8972 Y ° ` - - - -- 7?(--
' °
Ito will
l i)1 - S i .
Miami -Dade
T•
C C , v3Q g 07 .
MIAMI SHORES VILLAGE
Permit
Master Permit No.
Zip ,aL O
Phone #
Phone # ,P,,s ¢S o
e # 4a9,®
State Certificate or Registration No. 6 C/7/ Certificate of Competency No.
E -MAIL:
Phone #
Notary $ Training /Education Fee $
Scanning $ Radon $ DPBR $
/174%
Square / Linear Footage Of Work:
Zip
Type of Work: ['Addition ['Alteration ❑New p4, Repair/Replace
El Demolition
Describe Work:
******* * * * * * * * * * * *xxxxxx * * * * * * * * * * * * ** F x**xk******** * * *xxxxx * * * * * * * * * * *r. * * * * * * * * **
CCF $ l `GA.✓ CO /CC
Technology Fee $ 3-1S
Zoning $
', $
Now Due$ 1S - 1. SS
See Reverse side -
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
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: 1 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 fing permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commend t and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified co /�rrecorded notice of commencement must be posted at the job site
for the first inspecti, n which occurs seven (7) days after the dl ing) permit is issued. In the absence of such posted notice, the
/MI fl
inspection : . approved and a reinspection fee will be char g J, /
Sign
Contractor
The foregoing instrument was acknowledged before me this f)ij The foregoing g str thent was acknowledged before me this 02
day of iii
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Owner or Agent
State
2007, by f d 1 Cho
pe y , Sujellvc C ly0
My Commission Expires: '? °� ��: COMMISSIOP: # D066ZB43
,,���� ° EXPIRES A 2011
_ N ;"4'r afi61010Y g�e xxxxxx4e �kxx
APPLICATION APPROVED BY:
(Revised 02/08/06)
My Commission Expires:
Zip
Zip
day of O - , 2007, by i&' 4
wh is p known to mjr who has produced
as identification and who did take an oath.
NOTARY PUBL •
CONSTANT/NOARIAS
* MY COMMISSION tDD299755
N Bonded Thu Budget Notary Swipes
�txxxxrxxxxxxx*xx*w x xrx*xxxxxxxx we*
/�/ Plans Examiner
Engineer
Zoning