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RC-10-1179Miami 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 Permit Type: BUILDING JOB ADDRESS: Z cos ls� C'At--6 FBC 20 Permit No. 0-C — (0— l ® k V,1,9 Master Permit No, J P fn0 � H ! F:).5. ROOFING City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): f Au ��'�`� Phone#:0.66) Address: _& 60t e City: State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: 0 V,� I c< 61 t ` Phone#: Address: 1q ltF A (00z City: State Zip: Qualifier Name: Phone#: State Certification or Registration #: Contact Phone#: Email Address: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $—A "? Square/Linear Footage of Work: Type of Work: ❑Addition ❑Alteration ONew ORepair/Replace `emolition Description of Work: it"-oyoyjl. L a•F $o(ptr �� ( S F✓e Afl If r <itl t It / MC;! Q Of 1.4 C !U - j / r 7 ��► �Pe�/roc fir,` Color thru tile: cly 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 $ Bonding Cbmpany's Name` (if applicable) Bondin ,Cpmpapy's Address ,.. City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip zip Application is herbby 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�v h o Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of "SA , 20 94 , by �� p��l�� day of .20 _, by , who is personally known to me or who has produced '� r As identification and who did take an oath. NOTARY PUBLIC: IV1 S Sign: Print: S) m: My Commission Expires: ,N APPROVED BY '1/1 elf who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) 1 140 141 2-0310 00 s,,.G f� CY k% 110 - L..r1 Lf-TrGA. BUILDING 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 PERMIT APPLICATION FBC 20 Permit No. i:' -L 0 M Master Permit No. Permit Type: BUILDING ROOFING Owner's Name (Fee Simple Titleholder) Y ��,{ Q /� l ` �Ul �. Phone # a QA —5�1 Owner's Address City kka="t 4:,21,AjTog,- State T (r Zip Tenant/Lessee Name C22 Y-rX Phone # Email Job Address (where the work is being done) v. d O u, _ } City Miami Shores VillaeeCounty Miami -Dade Zip �� FOLIO / PARCEL # \ 1 ©6 - Ol ' FjCj rj C-) N Is Building Historically Designated YES, NO t/ Flood Zone CO,�lS . GlG 1.t/ ed�l / Contractor's Company Name � ^ � � pit Contractor's Address —S - city S- ST City�%'� �_� C State Qualifier Nam�G/",o /� O State Certificate or Registration No. 9 �� c;2 Contact Phone f`%v�l✓ G%l/�G! Architect/Engineer's Name (if applicable) Value of Work For this Permit $(�2_ Type of Work: ❑Addition ❑Alteration Describe Work: py Zip • Phone # `!Jr /o - e53,6 Certificate of Competency No. E-mail _ 1?/jC%I/Q • L��G �-ICl �� • @ arm ' !V Phone # l r Square / Linear Footage Of Work: ❑ Repair/Replace ❑ Demolition Submittal Fee $ _ Permit Fee $ CCF $ CO/CC $ Notary $ Training/Education Fee $ Scanning$ Radon $ ouble Fee $ `w Iructural Review. $ Total Fee Now Due $ DPBR $ Violation date: Technology Fee $ Bond $ See Reverse side -4 Bonding Company's Name (if applicable) _ Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 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 es ' ated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and constr it law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the r a ' f commencement must be posted at the job site for the first inspectio hich occurs seven (7) days after the b 'I issued. In the absence of such posted notice, the inspection will not J��rove*l %Nd a reinspection fee will be c Signature Owner or Agent The foregoing instrument was acknowledged bef� me this .1c� day of Q, , 2010, by C'gRI S 2=1 ni -1 who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: `,Sign re Contractor The forego g instrument was acknowle Iged before me this day of 20fid, by Cjl/!1/C/j who isersonally known to me or who has produced as identification and who did take an oath. NOTARYiPUBLIC: Print: t Si C- F4 Prim'' RICHARD M. MALCY My Commission Exp 2r P`e4� MY COMMISSION #DD831707 My 1$SkiQdsDQ67615� 1 4 EXPIRES: OCT 16, 2012 �z: �� "EXF`iRES. MAY 20, 2011 '�" 1 W' Av.AARONNOTARi co€ i � � Sor[10 through 1st state Insurance °`<< .� °��A APPROVED BY Plans Examiner Zoning Engineer (Revised 07/10/07)(Revised 06/10/2004) Clerk checked