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RC-11-231Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 �J Permit No. 1 F - 1 ' [ '551 Master Permit No. BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING 6911- OWNER: Name (Fee Simple Titleholder): J‘217441 110 10 Phone #: Address: d (d N 2 u4 J4 City: AA C 4- 5V-us J CS Tenant/Lessee Name: Email: FInn '4J I11 +R 6 1.2011 BY ....................... State: r Zip: Phone #: JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: / 6 41 / /i/F_ Z CONTRACTOR: Company Name: Address: e 2 7 q Cy City: VV' •' Qualifier Name: <«✓ d State Certification or Registration #: Contact Phone #: DESIGNER: Architect/Engineer: Ca1(d _ o #c n 9 S fi nn \State: b' kvk.e Z— Phone #: �(C s / 32 $>'S 7 i' Certificate of Competency #: Email Address: a ^J CO phone #: 3 °C' / ? Zip: rkm) Phone #: Value of Work for this Permit: $ `2 ° o Square/Linear Footage of Work: Type of Work: DAddress ❑Alteration New ORepair/Replace ❑Demolition Description of Work: pre l4 patty S 'Fo ( A- /c .T ays-1$ 1% s COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: * * * * * * ** * *** ******,t,r,r t***** * * * *** r**** *Fees** ** **, *** * * * * ****** rat** * ***,r ****** * *,r r*** ** Submittal Fee $ Permit Fee $ /0 0 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 co cement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued:- In , he absence of such posted notice, the inspection will no . approved and a reinspection fee will be charged. Signature Signature Ow r or Agent / Contractor The foregoing instrument was acknowledged before me this 2 The foregoln in ment was ackn ledged b ore me this /� day of �j , 20 '�4, by l 4,lAN - 4 a //'S , day o ry . , 20 i , by iL l/ F fI d�� who is personally known to me or who has produced Pef l� ho is pe sonall known to me or who has produced �� l D As identification and who did take an oath. , ' �e tication and who did take an oath. NOTARY PUBLIC: N I TARS PUBLIC: iii r 6 . �+'' '4, 0 t Sign: �� ... �` '% Sign: �/ + � .\ NN /O .�� cry �.. ,� �'^"�" Print: ' y Co ®�q4` 6�a/ as = Print: �‘).).\:4 .5;44 :,. f���i A� ®�� My Commission Expires: U�t ,, ,� �;• , '.°A" `�°� .�` o 'C�°c ,mot! ,/, /e �__'••••••••• '�• \ \` °•'set N yQ Ts "ii IlllllllO Plans Examiner Zoning My Commission Expires: APPROVED BY (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10) Structural Review Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33 Tel: (305) 795.2204 Fax: (305) 756.89 INSPECTION'S PHONE NUMBER: (30" 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING OWNER: Name (Fee Simple Titleholder): VOi1Ai '► c0 Phone #: Y8 • �4' • 89Q4/ Address: '70L/© / 2,Jo. \ernilt ermit No 115VMRYZFI,�, �� FEB 1 y 2011 D BY: City: Tenant/Lessee Name: Zip: 33168 Phone #: City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes CONTRACTOR: Company Name: CJWAfZ. Address: City: Qualifier State Registration Phone #: DESIGNER: Architect/Engineer: NO Flood Zon Pho #: State: gip: Name: Pho - #: Certification or Re istration #: Certificate o ! ompetency Value of Work for this Permit: Type of Wor Description f Work: ess 2-00F ail Address: Pho r a. #: ltera (Ze' / Square inear Foot e o ork: ❑New OR .'r/Replace ❑Demolition 00_ FEN - V.) 2. fsid6 COLOR THR GH R S F TILE I " QUIRED acknowledged by: ** * * * * ** * * * * * ** * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * *, *** * * *** * * * ***,r*,►**** * **** Submi ee $ Permit Fee $ /0 Q CCF $ CO /CC $ CPI Scanning F : Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City gate 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 Ai 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 musrbe 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 inspectio wh ch occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspecjon will not b ap. oved and a re spectipnn feej ill be charged. Signature t/ Signature Owner or ent The foregoing instrument was ac owledged before me this l day of , 20 \ ( , by it■ AvVZ_l , who is personally known to me or who has produced 3 U As identification and who did take an the NOTARY PUBLIC: Sign: Print: My Commission Expires: APPROVED BY 11% ,,t4;44. ■ y 4, % O 44 .e c, Z. o e; e Contractor The foregoing instrument was acknowledged before me this day of , ,20 , by who is personally known to me or who has produced as identification and who did take an oath. Plans Examiner NOTARY PUBLIC:• Sign:.;:, Pent: My Commission Expires: • Zcining Structural Review,, Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)(rev6/4/10)