FW-12-893Miami Shores Village r ..
�
Building Department M AY 1 7 32
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BY:
FBC 20
BUILDING Permit No. TW l Z-- 651,-)
PERMIT APPLICATION Master Permit No. CC,- (�'',�4I
C nn
Permit Type: reAr..1
JOB ADDRESS: V1,�QO IVE (F)
City: Miami Shores
Folio/Parcel #: 1 01I j 001276 40
Is the Building Historically Designated: Yes
County:
Wrki
Miami Dade
NO
Zip: 3,1b\
Flood Zone:
OWNER: Name (Fee Simple Titleholder): BD-Tr �tWJJJC15 \'j Phone #: 305 -I -3060
Address: 1130 Oa t4 r\-vi
j
City: Mt6.M\`kb S State: zip: 33 Vol
Tenant/LesseetN , ame: \ C'C1 \YMiS6\T1 Phone #: � ` iC —3050
Email: V '�C,`.' a Pte\\ . ‘0.0.-y . d a.11\
CONTRACTOR: Company Name: Cpl *xi ne#:c i rq3 ° 8if o
Address: b;ell 0-41. &II sP
City: 114 a *1 1 P State: PA42 Zip: 33 /66
Qualifier Name: M4.04 bgtfiaS Phone #:3c/ 2
State Certification or Registration #: d 74 qg Certificate of Competency #:
Contact Phone #: 0 ds) 5-93 '3510 Email 7 fix: pi € c 4Yf et
J c . cM
DESIGNER: Architect/Engineer: _ Phone #:
Value of Work for this Permit $ -I 1 0 00 Square/Linea a v ork:
Type of Work: Addition OAlteration UNew ORep + . e ❑Demolition
Description of Work: Ce.'
**** ** * * * ****** * * * ********** * ** * *** ***Fees r* ***** ** * * ** ***** *,r**** ** * ** *** r** t** * *** **
Submittal Fee $ Permit Fee $ 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 commencement must be posted at the job site
for the first inspection which occurs seven (7) d :;after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved a i einspectio ee ille charged
Signature
ditt
Owner or Agent
The foregoing instrument was acknowledged before me this 3
day of flA- / , 20 rt , by 5,244-c- fz S ,
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Cheryl Beide Gerber
My Commiss on DD966126
?oF f■P' Expires 05/0812014
Contractor
The foregoinf n rument was acknowledged before me this Qt
day of MAI rt"; 20 12-, by 141A1114- VA I ,
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commi sion
LIAJ
* * * * * * * * * * * * * * * * * * * * * * ***71 ***** **71t3eYY7FYY*stoltY *** *fif 71nin1nt 'ie*** *** **oi'7k11fY1n}l*i ***A'tUtk'i *
APPROVED BY
*
2O444Y P(,t, Notary Public State of Florida
.
Allan Capuano
a a My Commission EE054592
9OF Fli)" Expires 01 /11/2015
- *.-- 9rC -* * - *- *- * * : * - **
*
Plans Examiner Zoning
Structural Review Clerk
(Revised 3 /12/2012)(Revised 07 /10 /07XRevised 06 /10/2009XRevised 3/15/09)