SGN-12-0285Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 204157 Permit Number: SGN -2 -12 -285
Inspection Date: December 10, 2013 Permit Type: Sign
Inspector: Rodriguez, Jorge Inspection Type: Final
Owner: EVERETT, HENRY AND FRANCES
Job Address: 9600 NE 2 Avenue
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Buildina Department Comments
Work Classification: Temp Banner
Phone Number (727)461 -4370
Parcel Number 1132060132510
TEMP BANNER
Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed i
CREATED AS REINSPECTION FOR INSP - 170123. Need buss. street
number
Failed E]
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
For Inspections please call: (305)762 -4949
December 10, 2013 Page 1 of 1
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Miami 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
Permit No.
PERMIT APPLICATION
FBC 20
Master Permit N
PJF,c]F,z
FEB 16 202
BY:
Permit Type: BUILDING ROOFING
OWNER: Name (Fee Simple Titleholder): CLV Gye'Ar e Phone #: 0-7
Address: !� 6 (?—A.( 157 2 n, ek Au,-
d� � —e- 5 State: � � Zi 1
City: t CA' 1✓12 o p:
Tenant/Lessee Name: )�A yi Y v.,j Vn t k ) Phone #: V
(Email: ®l t" �� (o , &-t ti W o tjL Lc e, 6 A trial % Cz "4 t Ca v'&,
JOB ADDRESS: '9 (,2°I Z .C.-
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: Phone #:
Address:
City: State Zip:
Qualifier Name: Phone#: _
State Certification or Registration #:
Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: kddition DAlteration ONew URepair/Replace
rW Description of Work:
Submittal Fee
Scanning Fee $
Permit Fee $ 16 d CCF
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
ODemolition
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
Zip
� s
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 notbapprovfd and a reinspection fee will be charged.
Owher or Agent Contractor
The for ego'in//sttr�rumen�t/was acknowledged before me this 1 O The foregoing instrument was acknowledged before me this
day of a' J, 20 ± --by ��LT� -EC,2 CJ�mm �,�ay of , 20 _, by ,
who is personally known to me or who has produced fL 01 who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Print:
My Commission Expires:
APPROVED BY
e��1�U 111111 //
a
�aI Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Zoning
Clerk
.-I , •
co ida M i LIM,
ZL
------------------------------- -----------------------------
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APPRO'vED-j,---
ZONING DEPF
BLDG DLE LPTI_
SUBJECT 10 CCMF-I!,'j
STATE AND C(.,I-N, Y:j'� I'
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