PL-05-329Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tell: (305} 795�.p2�2 (305) 756.8972
V
BUILDING
PERMIT APPLICATI
FBC 2001
Permit No. f1015— 3Z `�
Master Permit No.,/SPc)5 — L -52A
Permit Type (circle): Building Electrical Plumbin Mechanical Roofing
L -&(a tee.
Owner's Name (Fee Simple Titleholder) i� Phone # 36 - qW s �
Owner's Address
CityV i_a_,x j S&e State Zip s/
Tehant/JLessee Name Phone #
Job Address (where the work is being done) "77 Ny LU 16
City Miami Shores Village County Miami -Dade Zip 331
Is Building Historically Designated YES NO_�,,Z�
Contractor's Company Name
��i�% Phone
Contractor's Address
City /" / /WIll
Qualifier I
State Certificate or Registration No.
Certificate of Competency
Architect/Engineer's Name (if applicable) Phone #
a
$ Value of Work For this Permit 00
Type of Work: ❑Addition ❑Alteration ❑New
Describe Work: K r re-oy\4 C�.
Square Footage Of Work:
❑ Repair/Replace
❑ Demolition
Submittal Fee $-0 Permit Fee $ 8 CCF $ C% Coo CO/CC.
Notary $ Training/Education Fee ®- Z Technology Fee $4 .. CX7
Scanning $ 3 •GQ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $ r_ ;
(Continued on opposite side)
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 is issued In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged
Signature "4" 4-64
"'
r
Owner or Agent
Contractor
The foregoing instrument was acknowledged before me this '7 The foregoing instrument was acknowledged before me this
day of 20 - by —4#za P t o iU OF J `Dr, day of APIEMELr .20 ar, by I—A M IV t L Y/�
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: NOT
My Commission
APPLICATION APPROVED BY:
Eign:
oaa so 61, ®1�
Print:%
My Commission E ices: yy ���q ��� Dec 25,200"
�B"Z.. y4rea Banded Thru
la—'gd. Examiner
Engineer
chc 05/13/03 Zoning
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
BUILDING
PERMIT APPLICATION
L
Permit Type: BUILDING (rjCjU_6_
JOB ADDRESS: 44yLU 10/ s�
City: Miami Shores County: Miami Dade
Folio/Parcel#:
Is the Building Historically Designated: Yes NO Flood Zone:
d ddv
FBC 20013
Permit No. R --C) 2—
Master Permit No.
ROOFING
OWNER: Name (Fee Simple Titleholder): F06 A V i Li, C Phone#: 30 g, 7-7-1- 5 Z 3
Address: c-' t
City: 5U M"� td e S State: L am. Zip: 3? 1 6 a
Tenant/I.essee Name: Al I f Phone#: /1/14
Email: f d111.jQ n d111.V 0 Cl i a C U '1
CONTRACTOR: Company Name Q ' 1 ��m � NQS �iL °1 Phone#: (301) 4Y I - ;� 7 qk
Address: 'JOO NW 10 �4 A
City: State: �L zip: !
Qualifier Name: / S /A U 4 // 11 Phone#:
State Certification or Registration #: CFO— ®/ g >O Certificate of competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
o®
Value of Work for this Permit: $ �00
Square/Linear Footage of Work:
Type of Work: OAddition�/ DAlteration �" UNew (y ORepair/Replace\ ODemolition
Description of Work: I/-! PLC (�P/1/1'1D C(,C I�GI l JLfI4 (/) �lLi Lw",SAaj
�u,e1 4-L /7 faC=L5- -- —;>2 -2
Color thru tile:
��x�����x�xx�x���xx���x��x���x���x� �xx�F�.�xxxx����xxx�x�xxxxxx��xxxxxxuxxxxx�x�xxx
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 $
.!tondiing 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 �)J YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPER',#� IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR
RECORDING YOUR NOTICE OF COMM
Q AN ATTORNEY BEFORE
Notice to Applicant. As a condition to the issuance of a building permit with an estim&ed 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 reinspection fee will be charged. , -1-1,
Iiiiii
f 1
IFPPPI _
Owner or Agent
The foregoing instrument was acknowledged before me this Iq
day of 20L?�,by tdVO1L01G 6�C`0
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign -
Print:
My Commission
APPROVED BY
KELLY J VILLA
MY COMMISSION 0 EES78405
EXPIRO February 28, 2017
Contractor
The forego' g instrument was acknokyledged before me this %9
day of , 20 L3— by dJA17/S
who is personally known to me or who has produced
as identification and who did take an oath.
'e? 2-45 Plans Examiner
NOTARY PUBLIC:
Sign:
Print:
My Commission
KELLY J VILLA
MY COMMISSION 0 EEA784W
EXPIRES Fobnoy 26, 2017
Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)