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KA(iA* Miami Shores Village
Building Department '`'I e�
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 ®CT - k- 2-0
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949 = Y--
FBC 20 t*a'
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.
♦ —0`�38�
Permit Type: BUILDING
JOB ADDRESS: !09 14 /®I SI
City: Miami Shores jell a jftW Dade Zip: -f�+l
Folio/Parcel# ll_3205-®Z� ®c�O i.
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): 1:;—a-9w-9, - L,z ff FAN Phone#: -��
Address: l4-7D Pr to l 4r.
City: ►A c sk10 S State: RQo aA Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: 15/pil o anoRw!z,^ Phone#: ;305-754-65;54
Address: /l107 HW 1O1 b'l'C
City: H,444 1 State: Zip: 33I Sa
Qualifier Name s Phone# 30�`751V-S 5-S
State Certification or Registration#: kektiate of Competency#:
Contact Phone#: Email Address: '
DESIGNER:Architect/Engineer: -'��-° Phone#:
®m
Value of Work for this Permit:$ 3 °°O° Square/Linear Footage of Work:
Type of W6 zUAddit ii° " DAlteration ONew ;(Repair/Replace ODemolition
as � �
Descriptio of WOT l .1 L I c� W A a°`
Color thru tile:
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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) A I A or-1
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: TO RECORD A NOTICE OF
COMMENCEMENT MAY - OUR 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 reinsmction fee will be charged.
Signature Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this J-_ The foregoing instrument was acknowledged befoore ?th44�'Z'
day of(,� ,20th,by �'tvtit e► [3M day of ,20 a,by C Y IG
who is personally known to me or who has produced me or who has produced
As identification and who did take an oath. t entification and who did take an oath.
NOTARY P LIC: ° � �ap_108_.5 5"-5&3 NOTARY PUBLIC:
Sign. Signr
y
Print: Prin ECA M.PASTRANA Notary Public- of Florida
My Commission Expires: My F ON 0 E s N24 MY ��9 +m.Expires Apr 14,2018
etm�my OVr+ o`' Commission#°EE 183833
APPROVED BY Plans Examiner Zoning
i
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
2
188 Devon Dr. CEID
Clearwater Beach, FL 33767 NOV is. cis
November 21, 2013
BY!
To City of Miami Shores Building Department:
Please close the Permit BP04-999 for window sign lettering,which is not on the window.The
location of the window is 179 NE 96th Street, Miami Shores, FL.
Thank you for your help.
Sincerely,
Frances Everett