BPP-13-2162Miami Shores Village
Building Department
1 90050 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
FBC 20
Permit Type UILDING ROOFING
Permit No.
Master Permit No.
OWNER: Name (Fee Simple Titleholder): t.JtOP1mgmer J�n� Phone#: 3<751— 3.334
Address: 95091 N$_ I " koA.0
City: M • 'Nw" State: Zip: 35 I S8
Tenant/lessee Name: Phone#:
Email:
JOB ADDRESS: 0A05 N`t •rg �-QAD
City: M1 iami Shores t County: Miami Dade Zip:
Folio/Parcel#: k `— !�lo " o I % — 1'J I o
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: Z44.40A QOOLN Phone#:
Address: I %-I )U 161 V- 6\,,,*
City:
Qualifier Name:
VK.,./
State Certification or RReeg�istratio �- �C. "®�`�`� Certificate of Competency #: _
Contact Phone#: 3 i �` 3 Email Address:
DESIGNER: Architect/Engineer: "`tel /�' Phone#:
Value of Work for this Permit: $ 0 to oo Square/Linear Footage of Work:
Type of Work: ❑Addition ❑Alteration ❑New ORepair//RcReplaceflfl ❑Demolition
Description of, ,Work: __kASii• %cc �X�a�. ,w�Mw�c:� P& 4t- nn ', ci f : 7�•+F + t,.M %& V
Submittal Fee $ �®_ Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Notary $
Radon Fee $
Training/Education Fee $
DBPR $ Bond $
Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable) r A'
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable) A 1
Mortgage Lender's Address
City
State
Zip
Zip
Ir
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 char ed,
Signature Signature
�1
Owner or Agent Contractor
The f egoing instrument was acknowledged before me this & The foregoing instrument was acknowledged before ..me this
day of�, 201 S , by Sllti•pL. ys/ day of a w1� , 20 L, by Nyto Cif✓ ,
who ipersonally knowno me or who has produced who i rsonally known to me or who has produced
NOTARY
Sign:
As identification an io ' take an oath. as identification anA-wlia4d take an oath.
NOTARY
0
My C mmission Expires: '6%'
_ Commission
APPROVED BY Plans Examiner Zoning
Structural Review
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
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JOB NO.: 95-9-•200
s s.m..s k Nasi nand vasa
DMZ: July 7, 1995
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F.M.&D..Pamd Wail son Disc
ISL Desi
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Lots 17 and • 18° in Block 96 of ANOMED PLAT OF MIANZ SHORES
N.ei.V.D. titnaL Ommmpbieal VaMieal Hadco
aW.0 c..ovmcbead t>ttuty I�ea
SEMON NO. 4, according to- the Plat thereof as reams
in Plat Book 15 at Page 14 of the Public Records of 'tom
o•c.a.M.•nade C*Vbty beach !lark
County I Florida•
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•%oalest•PmooeC
P.C.P. P� Oontmi. PDfat
Property street ASB:
(PIaAa.• pe� >ieooio8ed Nat
9909 N.E. 4th. Ave., Miami Shores,
IMI••dlea
Iciaa
DuComity Florida.
de
p.C.Urafta at Choc
T173.8 Survey is Certified - t0:
japs•
Joseph obernmeyer and Julie Oberweyer, his wife;
Distane.s
Walton, Lantaff; Scb roeder & Carson, P:A.;
Ca. CbW4_,njatzceoe
Attorneys' Title Insurance Fund, .Inc.;
Chemical Residential .Mortgage Corporation,sr;J_�
��n ��G ae.jV S:7
`' ,iv 9j.` -
Its successors And/Or Assigns.
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1.065
FLOOD INFORMATION: FLOOD ZONE a X FLOOD IIHSORAN�>lATE Ii�AP�
4093 (3/211994).
Nakao L- Wel va id "bW —1- —us. amhsessad smreyar's. wl: 2.-ZkVs90WSbWUQ=
. 3d Tib la a BuaaWdon►--
4.Fence eswstership gssumee3 ecoasr&we to the PUL" of. its _ elm, (. • �o k�l int .
5. Arrow shooin is' as per Plat Book 15. at Page 14,
I iWamy CIIRTWY_. TI`mf'4k* sant ted PLAN OPStIR4al' VW of I aboams doxtb rad , Is tan and comm to Nit other bss[ of my knai i gc and
IS acems �t��sz 0—ad %01M W ..lAoe�da Code. g Land Su pwsuant to
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LAW PLANNERS, SURVEYORS
Stabs P20et '• ' ` 49it W.W. 79 bra. &Aft ! S, M —, Fl. 33165
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