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RC-09-291.. Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING _Ejj rS RD) Permit No. 1 -' j PERMIT APPLICATION F B Z 7 aster Permit No. FBC 2004 i''/ ! 1 Permit Type (circle): Building Owner's Name (Fee Owner's Adtlres� City / . o Tenant/Lessee Name Titleholder) '5I/A Roofing i db AZCLOI� Phone # '%O 4'" 0'77;;r-M� 46 State ��L• Zip �/X?7 .f / L. Phone # Job Address (where the work is being done) /& 0 A 4t), 94794 97, City Miami Shores Village County Miami -Dade Zip 3.3 /4`67 FOLIO / PARCEL # _ w Is Building Historically Designated(J4!f/A NO__X_ Contractor's Company Name Phone Contractor's Address /`(0 S -Y O City , '�%.�� dr�S_ State rX Zip /Sr�Q Qualifier Name State Certificate or Registration Architect/Engineer's Name (if applicable) Value of Work For this Permit $ Type of Work: ❑Addition ❑Alterrattion Describe Work: 45 C. %(, ry 4// L Certificate of Competency No. Square / Linear Footage Of Work: ❑Newer A " 6L Repair/Replace ❑ Demolition �-V1u�,,� Submittal Fee $"- Permit Fee $ /0 �� CCF $ � -47 CO/CC Notary $ J' Training/Education Fee $ ; ._ Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ See Reverse 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. �4z, Signature Signature Owner or Agent Contractor The foregoing instrument was ackknnjow)ledgted be re me this �--1 day of , 200jt , by ►lU(<lY0 910.) who is personally known to me or who has produced til'• ` bL S4LltO As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: The foregoing instrument was acknowledged before me this day of 20 _, by who is personally known to me or who has produced s'z`\S�F�piu� identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: My Commission Expires: APPLICATION APPROVED BY: (Revised 07/10/07) Plans Examiner Engineer Zoning ��' Mc M97m Miami re Village MAR 2 0 2009"�� Building Department 44\4 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 V-kaµ Tele (305) 7952204 Fax: (305) 756.8972 BUILDING Permit No. ' PERMIT APPLICATION 0 Master Permit No.a= .-07>t I F"BC 20 Permit Type: ELECTRICAL Owner's Name (Fee Simple itleholder)/ one# '40 Owner's Address O '"' 9 ,97-516r City i • t i'P�![ State TL/ 1p 33-40 Tenant/Lessee Name Phone # Email Job Address (where the work is being done) Ay dZ160 City Miami Shores Village County Miami -Dade Zip .33/XV FOLIO / PARCEL # Is Building Historically Designated YES NO Flood Zone XAF Contractor's Company Name /fla/", Phone # m4f, - 49r_ Contractor's Address © Al. 9AX CitJ. s�l�1"a?.� State �'L Zip �'K► . Qualifier Name State Certificate or Registration No Contact Architect/Engiineer's Name (if applicable) __ Value of Work For this Permit Amd Type of Work: EAddition Certificate of Competency N E-mail Square / Linear Footage Of Work: r9New ElRepair/Replace ® Demolition Submittal Fee $ o—rPermit Fee $ AgF�4 CCF $ ,/SCO/CC Notary $_ S_Xb _ T raining/Education Fee $i%>> Technology Fee $ 400 Scanning $ W Radon $ DPBR $ zoning$ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ 4 • See Reverse aside f-;. 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 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 inspectionwhich 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 4K� Signature Owner or Agent Contractor The foreg i g instrument was ack wledged before m is The foregoing instrument was acknowledged before me this day o 200q, by day of 20 , by 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. NO ARI' PUBLIC n ��s NOTARY PIJBLIC. Sign: Print M Sign: Print: My Commission Expires: APPLICATION APPROVED BY 0 1p�y O1 Plans Examiner Zoning Engineer Clerk checked (Revised 07/10/07) i ¢ This In Pre atetJiQt� Name r 44 Address _ OY `` '(Y11� &sir Permit No. Tax Folio Nol -ava NOTICE OF COMMENCEMENT STATE OF emirs ti- COUNTY OF _ THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property, and In accordance with a Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. W a s� LIE 1. Description of properly: (legal description of property, and street address if available) w X06 Al ria&rr+, rn ¢ 2. General description of 'rnprove ent: ? �_ i K� -4V7 2= � 3 =r- ^ D 3. Owner information Aj I •' a. Name and address: b. Interest in property: r,-jh� rit, c. Name and address of fee simple titleholder (tf o her a ow �n m0,o wCl Al%v -7 ! 0 i p. �onlractor. /6d p c W In [y -jb. a. Name and address: Phone number: Gtr.i �j ,C_; ,. 5. Surety : a. Name and address: C b. Amount of bond $ W o O u i' c. Phone number. G L.1 ¢ r pWC� C14 6. Lender o S- C." W o� a. Name and address: U- w ¢ ¢ b. Phone number: 4.s tt 7:-J 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes: a. Name and address: b. Phone number: 8. in addition to himself, Owner designates the following person(&) to recelve a copy of the Lienors Notice as provided in Section 713.13(1xb), Florida Statutes: a. Name and address; b. Phone number: 9. Expiration date of notice of commencement (the expiration date is 1 year from the date of recording unless a different date Is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, 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 AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER ANAIS IRt�EY BEF COMMENCING WORK OR RECORDING YOUR NOTICE OF CTNCEA%ENT. �s(/J(/i/`� ! fly ature of Owner or Owne s Autho ed OfficedDirector Partner/Manager Signatory's Title ifica The for n i ant was acknowledged before me this A --day of , (year) by ft= (name of person) as(type of authority, ,,.e.g. officer, trustee, attorney in (act) for _(name of party on behalf of whom Instrument was executed).4hk NOTARY PGBI:C-STA v OF 1 � S�Notery State of Florida Cuu-lulOs Print, Type, or Stamp Commissioned Name of Notary Public Comjssi08 il DD747923 Commission Number W Eltpites: SEP. 23r 2011 n,�i �l ,ND&UT"U AlLAl' nCBONDIM000-9V- Personally Known _ or Produced Identificationi� j 1J Verification Pursuant to Section 02.525. Florida Statutes Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true to the best my knowledge and belief._r S IAI OF FLAK A, 00LWT1(OF DAM I HEREBY CER77FY met fh, is q t GWY Of ft - COI ,�e on �4 , txi�trrat tiled in tris oa ores r A o 20— wrr Zand o�.rer . HA VE RAJ 114, CLERK, o/Cir and County Cour#& " '3'�►ia� � �Ii�11T/j��r�/��� raw„