RF-14-2884
` Miami Shores Villaize
Building Departmen '�'����
10050 N.E.2nd Avenue, Miami Shores, Florida 33 38 FEB 1120
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.
BUILDING
PERMIT APPLICATION
Permit Type:
JOB ADDRESS:
BUILDING
City: Miami Shores
Folio/Parcel #: \\ — S I () I — ®?_ 4 —
FBC 20
Permit No.
Master Permit No. L
ROOFING
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple
City:
State:
-65 1s®
r � .
TenanV1,essee Name: Phone #:
Email:
CONTRACTOR: Company Name: C G� Phone #:
Address: �� I '�"W �
City:
Quali
State
ContF
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑Addition
Description of Work: .X
OAlteration
Color thru tile:
ORenair/Renlace
DDemolition
Submittal Fee $ Permit Fee $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
No
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 roust
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 reinspection fee will be charged.
Signature
Owner or Agent
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.
NOTARY PUBLIC:
Signature
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.
NOTARY PUBLIC:
Sign: Sign:
Print: Print:
My Commission Expires:
My Commission Expires:
APPROVED BY �S c Plans Examiner Zoning
Structural Review Clerk
(Revised 5/2/2012XRevised 3/12/2012) )(Revised 06 /10 /2009)(Revised 3 /15 /09)(Revised 7/10/2007)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
FEBUARY 18, 2014
Permit No: RF 14 -288
Buildina Critique Review
1. Provide color sample of paint to be use.
2. Paint color to be approved by zoning.
3. Down spouts should drain a minimum of 12" away from the wall.
Ismael Naranjo
Building Official
Plan review Is not complete, when all Items above are corrected, we will do a complete
plan review.
If any sheets are voided, replace them with new revised sheets and place behind the most
current page.
City
' (i - )
Yi[
MerWage Id's Name (M amicable)
Mortgage Lenders Addrow
0
TM
Application is hereby made to obtain a permit to do the work and installations as indicated- I comfy drat so work or imstallem has
commenced prior to The issuance of a permit and that all work will be performed to meet the sMnft& of all laws regulating
construction in this jurisdiction. I understand that a separate permit mast be secured for ELECTRICAL WORK, PLUMBING, SHNS,
VMI S, POOLS, FURNACES, BOMMS, HEATERS, TANKS and AIR COMMONERS, ETC. --
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in comphmce with all
applicable laws regulating construction and zoning,
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
CONMENCENEM hIAY RESULT IN YOUR PAYING TWICE FOR
EMPRO + + VTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COh MENCEM[CNT:'
Notice to Applicant: As a condition to the - e of a building permit with an estimated value exceeding $2500, the applicant must
promise i n good faith that a copy of the notice of commencement and construction lien law brochure will' be delivered to the person
whose properly 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 nonce, the
inspection wilt not be approved and a rebupection fee wilt be charged /} `j
NOTARY PUBLIC:
Sign:
Notary Public Stets of Florida
Joanna M Felloloo
My Commiseicn FF 082783
Mw @n 501"il 09®
APPROVED BY L� .
NOTARY PUB C:
sign:
My Commission Ea
hpq Icr. too (fo
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Structural Review
(Revised3tl2iMl2 OBI MI 3n5M)
MARIAA RMRIGUEZ
W COMMISSION # EE 196139
. EXPIRES: May 6, 2016
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