RC-13-762Miami Skores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fag: (305) 756.8972
INSPECTION'S PHONE NUMBER: (3057 762.4949
BUILDING
PERMIT APPLICATION
APR 5 2013
r ,
FBC 20 0
Permit No.
Master Permit No. tz C -
Permit Type: BUILDING ' ROOFING
JOB ADDRESS: Z_ '� N Uj J- ®tr'¢—e �
City: Miami Shores County: Miami Dade
Folio/Parcel#:
Is the Building Historically Designated: Yes
OWNER: Name(Fee Simple Titleholder):
Address: ?, /U uo 1 .
city: K 5 Le --*7—State:
Tenant/Lessee Name:
Email:
CONTRACTOR: Company
Address:
City: `A z Z""
Qualifier Name: 0— 6—
NO Flood Zone:
r-: -r' C-0-�
State Certification or Registration #: 0- 6 e- ® S -4' @"
Contact Phone#: S- Z 1 t s _2 Z _I- Email Address:
DESIGNER: Architect/Engineer:
5 I_ 7.8aZ
11 1 ?, q
t�%Phone#: 3V `J Z I e rZ Z. Z1�
of Competency #:
Zip: t
3s',5 _Z I t® ,Z Z 2 -
Value
Value of Work for this Permit: $ $ e -Sc;k� � Square/Linear Footage of Work: CL -'Z7 S C�- Yf-
Type of Work: ❑Addition ❑Alteration ❑New 5 Repair/Replace ❑Demolition
Description of Work: K c:. apvi �
Color thru d1e:
Tc -11*--
Submittal Fee $ 001Permit Fee $ CCF $ CO/CC $
In�Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 453.
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.
a
Signature —AZ Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me thi* � The foregoing instrument was acknowledged before methisj
day of f r`� , 201- by C4K2A-� � +�CXa ((jU,L Lday of (� . 2013, by EDV �N 1 E– I 'D �l�
who is personally known to me or who has produced t 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:
Structural Review
(Revised 5/2/2012)(RGvised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09XRevised 7/10/2007)
Clerk
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE Jag'SITE A! yllp.!* M pWpECRW
PERMIT NO "A ZTA P000 No, 3,4;o 0 5 0
STATE OF FL61RIDA.
COUNTY OF MIAMI -DARE:
THE LINDERSIGNED.heriby gives noticsihatImprop verpents will be made to certain real
property,FloridaStatutes, the following hbmation
and In abhoorda�a with (I Flo6
Is provided In this Notice of Commenooment
1i
2. Description of
LIM��
CFH 2013R6392776
OR Bk 28635 Ps 3712; (109)
RECORDED 05/17/2013 16:10:37
HARVEY:RUVINP CLERK OF COURT
KIAOI�IJADE. COUNT YP FLORIDA
LASST PAGE
use of recording office
3. Ow1*8) nine and adtress: P - V- - Z1 VW
Interest In property: 4 -
Name and address of fee simple titleholdeit
4. OonbwtorlsMame. address and ahnne number.-tAtrz-,&.;
S. Surety: (Payment bond required by ownerfromcontractor, if my)
Name, address and phone num
Amount of bond
6. Lender!s name and address:
7. Persons wftbi6 theS
.1 1, within , State of Florida designated by Owner upon whom notices or other documents may be served as provided by
Section Florida Statutes,
, tr I I I Statutes, C I * ^ill &01 A) E I
Name, eiddreei and Phone number— - — - b
8. In addition to hIftelf, owns m designates the following person(s) to receive a copy of V I.JenoetNotice as provided In Section
713.1 3(1^ Florida Statut".
Name, address and phone number.
9. Expiration date of this Notice of Commencement
#N eWregm dde Is I yearftm ft daW of mwnft wkw a dftwd date Is spodW
WARNING TO OWNM- ANY PAYM M% BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENTARE CONSIDERED
CHAPTER
IMPROPER PAYMENTS UNDER
;=M 3, PART 1, SECTION 713.13. FLORIDA STATUTES,AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR. PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED ANDPOSTEDON THE JOB WE BEFORE THE
FIRST IN'
,SPECTION, IF YOU INTEND To OBTAIN -FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK
ORAEO61415ING YOUR NOTICE OF COMMENCEMENT.
Signatures) ofor C cer/DirectDr/Partner/Manager
'Pri �2 M�eJWZ!zed OM_
Prepared By
27� 7
Print Print Name
Name S
Title/office Tille/Office
STATE & FLORIDA
COUNTY OF. MIAMI -DARE
The -shument roknowledged before me this
0 gh
was 3 day of
'1117dM or " as for
Q Person*
ars 1
or *�nolwn. or produced entification: A�r_�ee'f 0,4--
Sk,�nature of Ngtary Public'ZIflit try,"
Print Name:
(SEAQ
VER[ROAa - ow
,=N PURSUANT TO SECTION 02M& FLORIDAFWRIDA
Under pehattles of penury, I declare that I have read the 10regolng and
that the facts stated In it are true, to the best of my knowledge and belief.
Sig re(s Officer/01ractor/Parftw/Manager who signed
natu ),of Owners) or
!r(o '�Wer(s)'s Authorized
BY 4� BY
10.01-52 PAW$ ano 1111111
NO POINT ALONG COUNTER TO BE MORE THAN
2 FEET FROM Gh PROTECTED RECEPTACLE.
J PUT D/W RECEPTACLE UNDER SINK.
'r) ALL FIXED APPLIANCES ON DEDICATED CKTS.
EIT V
til arni Shores Village
Ila
C.11
A AF. I I'tl, I
PPRQVEO.-4
----BY
DATE
ZONING DEPT
BLDG DEPT
SUBJECT 10 CCNIP1 V NCE WITri AU FEDERAL
STATE AN,) ur-f-jN, ( HLL_S AND REGULATIONS