DS-13-1408 (2)f
to
BUILDING
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
NSPECTIONTE NUMBER: (305) 762.4949
PERMIT APPLICATION
Permit No.
+� ,
FMAR 18 A014 l
FBC 20
Master Permit No. <ti/ ,13 --� (( o
Permit Type: BUILDING ROOFING
JOB ADDRESS: / /(0%' )/n
City: Miami Shores County. Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): ���C�(� / SIT/ Phone#: �7�� 20 z
City: k -e �- /3/.SeA >/tss,e — State: :rz Zip:
TenanVLessee Name:
Email:
CONTRACTOR- Company Na/me:'/�.Z&a& %l Ph95-3— 7K7
Address: V'Vo 54x"/67-
City:
T
City: / State: Zip:
Qualifier Name: 401 %(/fifvEZ Phone#: /I - ss-?77y�—y
State Certification or Registration #: Certificate of Competency Ma 53
Contact Phone#: Email Address:
DESIGNE ( � hitec ngineer: IM Am-- , C^111P -5 tlA. Phone#: � � S Z�, s 3 ° 3
Value of Work for this Permit;
(cam. '+
-. $ � � Square/Linear Footage of Work:
Type of Work: DAddition DAlteration
Description of Work:
S-( r P s
Color thru tele:
Submittal Fee $ Permit Fee $
Scanning Fee $
Radon Fee $
ORepair/Reolace ODemolition
CCF $ CO/CC $
DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
7
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
--c--
---c--
Zip-
Zip
Application
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 commencemej t must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the abs ce of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
PA
a -
Signature Signature
_f
Owner or Agent
The foregoing instrument was acknowledged before me this
day of �cx 20 &, by .,ALR�I,.�
who is personally known to me or who has produced
an oath.
RODRI VAREZ
NOTARY P
_` ?' MY COM S N #EE884004
r
T
i EXPIR March 14, 2017
Sign: (407) 39MI53 rl COX=
Print:
My Commission Expires:
APPROVED BY
The foregoin instrumevnt w� acknowledged before me this '/7.
day of. , 20, by�9� f(/�fZ
who is personally known to me or who has produced
>•�o w A4� cULJHI AL A) calREZak
a oath
NOT,II(a�r conn ISSIO #EE884004
17Z,i��oP, EXPIR arch 14, 2017
'31'
Plans Examiner
Structural Review
Sign:
Print:
My Commission Expires:
(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)
�2 / �/ Zoning
Clerk
Miami Shores Village
Building Department
BUILDING
PERMIT APPLICATION
id Avenue, Miami Shores, Florida 33138
D5) 795-2204 Fax: (305) 756-8972
LINE PHONE NUMBER: (305) 762-4949
FBC 20
Master Permit No. p5 I b " ftO Y
Sub Permit No.
BUILDING
❑ ELECTRIC
❑ ROOFING REVISION
❑ EXTENSION
❑RENEWAL
❑PLUMBING
[:]MECHANICAL
❑PUBLICWORKS ❑ CHANGE
CONTRACTOR
❑ CANCELLATION
❑ SHOP
DRAWINGS
JOB ADDRESS: '30—)
City: Miami Shores County: Miami Dade Zip: J D lS C)
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 8'a)(tr-W Liw'vc< Phone#:
Address: 31) `i N C � S � S -c
City: Idol i/tl� 1 S S State: t aLLv,7 A- Zip: 3- ((�'
Tenant/Lessee Name: Phone#: 36
Email: (oat 0 4 4T-tAkI L- COM
CONTRACTOR: Company Name: M� &W14 CiL4C� I iN L Phone#: —�t56 F65I -;)r,4 6"44
Address: � l () 9 I 5T
City: 4�'N� State: Zip:
L N &A ° ��t! -e rJ V n% 4A,
Qualifier Name: Phone#:II
State Certification or Registration #: Certificate of Competency #: Q V 9� "J�
DESIGNE . Arch'ite Engineer: A4 -V— C 0 C�� Phone#: 30S 2� ° 3 a 3 %
Address. �%�
�1'L-- City:
State: tt-
Zip: .7 313 6
Value of Work for this Permit: $
Square/Unear Footage of Work:"
Type of Work: ❑ Addition ❑ Alteration ❑ New
Description of
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Permit Fee $
❑ Repair/Replace ❑ Demolition
CCF $ 1 CO/CC $
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 construc' ien law bro ure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded n tice commenent must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit issue . In the a Bence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature `
Owner or Agent Contra or
The foregoing instrument fwas acknowledged before ee this The foregoing in trument was acknowledged before me
this day of , (/20 � by �C► IV �)°'Tl�km day of 20 � by M LA '� ciJV JV
!2
who is personally kn wn to me or who has produced who is personally known to me or who has pro uced �L —
As identification and who did take an oath.
NOTARY PUBLIC:
identification and who did take an oath.
ARY PUBLIC:
RODRIGO ALVAREZ
EXPIRES March 14.2017
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)