RC-14-2099 A�
Miami Shores Village # M
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 . }
BUILDING Master Permit Noyp
PERMIT APPLICATION Sub Permit No.
OBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL E]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 11004 NW 2 AVENUE MIAMI SHORES FL 33138
City: 02 \`Miami Shores 0()?--` uoount : Miami Dade Zip:
Folio/Parcel#: 1\— 21� - 0y ) Is the Building Historically Designated:Yes NO
Occupancy Type: SINGLE FAMILYLoad: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder):LSP HOMES LLC Phone#:305-527-3643
Address:11004 NW 2 AVENUE MIAMI SHORES FL 33138
City: MIAMI SHORES FL State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: COPi-S ur I! Phone#: 'MS- 2"41715"1
Address: Z�q /VrrL✓ /73 2�ic,
City: State: FL Zip: 1214 9
Qualifier Name: e /'�, i� el Phone#: S'Zyy r?gl
State Certification or Registration#: Ce�'C �s�v`�Ig� Certificate of Competency#:
DESIGNER:Architect/Engineer: CHARLES C. MITCHELL I
Phone#:
Address:924 N. FEDERAL HIGHWAY City: HOLLYWOOD State: FLL Zip:
�
Value of Work for this Permit:$ ,& gn1'�� fSquare/Linear Footage of Work: 4290�+
Type of Work: X Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: TOTAL RENOVATION, NEW ROOF, NEW ADDITION, NEW PLUMBING AND ELECTRICAL
Specify color of color thru tile: r�
Submittal Fee$ Permit Fee$ CCF$ CO/CC$ W
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ Q�/
TOTAL FEE NOW DUE$ tr0
(Revised02/24/2014) ISO
i
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 FCIR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT URLENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT." «' � r
Notice to Applicant: As a condition to the issuance of a building permit w h 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 sev (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be pprovedand arensp ction fee will be charged.
A
Signature � Signature
4NERorAGENT CONTRACTOR
The foregoing instrumentwas acknowledged before me this The foregoing instrument was acknowledged before me this
day of %I Kai GiS 7 .20 I/u ,by .s'"4 day of 414q &(-5j 20 7 by
who is personally known to Grrl //r ! who i personally known 0
me or who has produced ,uli✓BPS L,'t011 Se- as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
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Print: S Print: M IgoJ or,s
Seal �"'" JAMIE JENKINS Seal: �'"Y"" JAMIE JENKINS
MY COMMISSION#FFOO"45 MY COMMISSION#FF009945
EXPIRES:Apri121,2017 EXPIRES:April 21,2017
P!
APPROVED BYf��lu Plans Examiner / Zoning
y Structural Review Clerk
(Revised02/24/2014)
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LINDA KIRKSEY
Commission#, FF 4796
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My Commission Expires
April 03,,201 1
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