CC-12-0979Miami Shores Village
Building Department MAY 2 0 2at2
10050 N.E.2nd Avenue, Miami Shores, Florida 33138,
Tel: (305) 795.2204 Fag: (305) 756.8972
INSPECTION'S PHONE NUMBER: (3057 762.4949
FBC 20
B I DING Permit No. CSI 'd,
PERMIT APPLICATION Master Permit No.
Permit Type: BUILDING ROOFING
JOB ADDRESS: U.'500 ® & E= g k KX
City: Miami Shores County: Miami Dade Zip:'
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
City: Kroet -'fig State: Zip:
Tenant/Lessee Name: 'ge -CT l IG�► ��c r Phone #: SW
Email:
CONTRACTOR: Company Name: `
Address: rcegi"a"
City: I'R
Qualifier Name
State Certification or Registration #: rte+
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer-
of Competency #:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: QAddition OAlteration 1 ONew nORepair/Replace ODemolition
Description of Work: inAex1��
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
TOTAL FEE NOW DUE $
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
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 i ed. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
r .g,
Signature Signattf
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The forego' trument was acknowledged before me this
day of , 20 _, by day bf , 20 _, by ,
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
NOTARY PUBLIC:
Sign: Sign:
Print: Print:
My Commission Expires: My Commission Expires:
APPROVED BY
Plans Examiner
Structural Review
(Revised 5/2/2012 )(Revised 3 /12/2012XRevised 07 /10 /07)(Revised 06 /10/2009 )(Revised 3/15/09)
zoning
Clerk
� L -Lr1
DING
Miami Shores Village
Building Department
10050 NZInd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fag: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
PERMIT APPLICATION
FBC 20
Permit 1yw. BUILDING
Permit No.
Master Permit No.
�P-F-cEavEn
FEB 0 9 212
X85': f::7w —C-3�(49
OWNER: Name (Fee Simple
iI "t I.— — I^
Tenantll,essee Name: Phone#•
Email:
JOB ADDRESSi K 1 >U V a t7 4id/ NVV I
City: Miami Shores County:
Folio/Parcel #:
Is the Building Historically Designated: Yes _
NO Flood Zone:
aJ""t q ,2?
State Certification or Regiitm ion #:
Contact Phone#:; Email Address:
DESIGNER: ArchitectlEngineer: » - Phone#:
Value of Work for this Permit: Square/Linear Footage of Work: _. i
Type of Work: OAddress OA on ON vt ORepair/Replace .. �LIDemolition
Description of Work: d� t"1't P.�.'el Gt +Y )�� i
v v
COLOR THROUGH ROOF TTLEISREQULUM adbwwledged by:
,�,��r,► rya, r, e, �, �, a, �aate�rr��, �, �a�, a*, �*, �, ro, �, �x*, ra* a�aF�x *,�,t,� *a,�,�ea * *.a * «as��,� *,� r, � ,�ra,a�ra,�,�sa &�a���rr�a� *,��a
J
Submittal Fee Permit Fee $ ! / � d CCF $ CO/CC $
Radon Fee $
SeanningTec $
DBPR $ . Bond $
Notary $ TrainingWocation Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
• r Bon1ling Company's Name (if applicable)
Bonding Company's Address
City
State
Mkstgage Lender's Name (if applicable)
Mortgage Lender's Address
►LC
State
Zip
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 *9 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 condWon 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 a 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 afzj reinspection fee will be charged.
i
Signature Sign e
Owner or Agent Con r
The foregoing instrument was acknowledged before me this 3D
day of. ii 20 IZ, by V(�`" M RQW40S
Who is me or who has produced
As identification ho did take an oath.
NOTARY PUBLIC: CA Al f+r/ a . _
I &Ivia; 17, 1
My Commission Expires: t
12, 2014
tMaaft
The forego instrument was acknowledged before me this
day of 201Z- by
who is kno me or who has produced
APPROVED BY 4�a� r r I71-j- Plans Examiner
Structural Review
(Revised 07 110107XRwAsed 06110/2009XRevised 3/15/09)(wW4/10)
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
ANA M. TORRES
Print: - • 3 &1y Comm. Expires Jul 7, 2015
•.,,F rssIon 1 1
My commission t; Bonded Through National Notary Assn.
OWN
�aaaadra�oik,a� &,tt, serif, a* kda�r, ra* airrrntartrArrrrsk *i *�rdeir�r *dr
Zoning
Clerk