WS-14-1471 Miami Shores Village
IVED
Building p Ju Department 162014
� u �
10050 N.E.2nd Avenue, Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 BY,
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit No.�
PERMIT APPLICATION Sub Permit No.
n
XBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: ®a /0 CL) /00 ejT
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:r J
OWNER:Name(Fee Simple Titleholder): '0 62/'55 Phone#:2)0'S YVC9 ( Y /
Address:' f
City: Stat Zip:
Tenant/Lessee Name: Phone#:
Email: ff c�
CONTRACTOR:Company Name: �U J c � Phone#: �y` 25 1
Address: Z /
City: i'd� /� State: C �� �� Zip:
Qualifier Name: Phone#:
State Certification or Registratio #: eC—C 00 tyO!y Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 6.0e 000 Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration F-1 New
` Repair/Replace [:1Demolition
Description of Work: i,�� /,[3 �� lu� (iC/ / �2J j O C�$ C� Too 0 2
7-1
.0
Specify color 6f color thru tile:
Submittal Fee$ Permit Fee$ CCF$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address a
City State Zip
Mortgage Lenders 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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES,BOILERS, HEATERS,TANKS,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 not} a of commencen nt must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is sued. In thea nce of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument wasacknowledged before me this The foregoing instrum t was acknowledged before me this
day of ,. 20 by day of/ 20 by
,who is personally known to who is personally known to
me or who has producedTip Cn - ��i e��Q l as me or who has producedG� as
identification and who did take an oath. r identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: -61 177-
Sign:
Print: )' Print: j
Seal: Seal: "N�r PuNie�of Raids
I
Notary PuMit State of FiaidaJuan J Diego , Juan J Dia®o�*
E yCeommtEs 140684 g. ro+� ME ys'onsEg1A0894
* >K * t�
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
iami Shores Village V
q
ildin Department M
g p MAY 12015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
I•
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit No.
rBL
IT APPLICATION Sub Permit No.
ING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:— 4�;L 5 �'V (til 2 .3-7—
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: V lood Zone: BFE: FFE:
OWNER:Name Fee Simple Titleholder): -3e9 C06 Phone#: 61�_jc 3
Address: „QS- r'r yd y / a-0 5pq-
.
City: kai State: ! /lop Zip:
Tenant/Lessee Name: ,"Phone#: --
Email: I ,
r-c>" C-rrr�o
CONTRACTOR:Company Name: Phone#: 0� S�O� a 9,5Q
Address: `fir
City:_/• y�� m State: Zip:
Qualifier Name: ' ! Phone#:
State Certification or Registration#:��c 0c0 , t3 y Certificate of-Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Valuenf-Wor-for-this_Pe_rmitr.. Square/Linear Footage of Work:
Type of Work: ❑ AdditionAlteration ❑ New ❑ Repair/Replace ❑ Demolition
_ r- t
Description of Work: Y3yi' C _ CtIA
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES,BOILERS, HEATERS,TANKS,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 Signature' /
OWNER or AGENT �RACTOR
The foregoing instrument was acknowledged before me_ this The foregoing instrument was acknowledged before me this
day of A� A 020 15 , by day of 20 �Z by
bac CL k-. 6 �e`-3bQC'1who is personally known to G,O Cc VC9 is persona to
me or who has produced WT DL-41,2621421IA2,�R&s me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLI NOTARY PUBLIC:
F�iv�� p9tlC0��calSw�ag�g,�U�5
'c �PiAES:J 1� 1na�raac"!'
Sign: Sign: --
Print: �`�'� ^`� Print:
lga.. Lina Lasso
Seal: ,d1�!-N". Seal:
` COMMINIONW043009
IOIPIRE9s AUG,05,2017
wwWAMNOTARgum
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APPROVED BY t�J Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
,a 4
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4 Invoict
ex-C=fsAl
ice: 10 305-440-".T o
Dw DW*: 10.M4 78&&&6&
so T®:
IMIM100sbw
FL.
Re0amMidomanddoors 1 $1, OO M .f
repiam 13 wirdows and 3 exterior doors.
.
Got city'
Labor and"
JUL
�Cates non,-taxab L.itsm
.t+....:T................tt.aa.e..... ..,.......,. ......................................................................:..
5 Subtotal $1'900.00
TAY, 000`1%) $0.00
Total $1,900.00
Pa±d $0.00
Balance €e $1,900.00
AUG:17 2015
BY:
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Notary PUbIIC State of FloridaJoanna M FelicianoMy Cal"MI®alon FF 082753Expires 01!12!2018
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