RC-13-1253 • 1 . Miami Shores Villag
Building Department
s -2442014
l 10050 N.E.2nd Avenue,Miami Shores,Florida 3313 Y;
l� Tel:(305)795.2204 Fax: (305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.49
BUILDING(_C "e- O v Cc
ov��r .CNC-T'
Permit No. FBC 20
PERMIT APPLICATION aster Permit No.R.C. I -- US-3 .
Permit Type: BUILDING ROOFING
JOB ADDRESS: (�)—) A). W. /06 S�
City: Miami Shores County: Miami Dade Zip: 33 S�
Folio/Parcel#: UP- 008-
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): Phone#:
Address: 1Oiv / eQ�_
City: �Q/�1�B State: L Zip:
Tenant/Lessee Nie: Phone#:
Email: G
4!!�_ /1 �S'� �
CW
CONTRACTOR:Company Name:
,' Phone#: �f4 -c.RS�33J�`y
/V
Address: 10c, ' W M•. 14(/
City: State: L Zip:
Qualifier.Name S a Phone#
State Certification
�orj /ggistration#: (f h r �S�0��'9 Certificate of Competepcy#:
Contact Phone#: ` b Email Address: Qf�OS O- ftA04, ti1e
DESIGNER:Architect/Engineer. 4 URS hone# as' . f� yi 7 y
Value of Work for this Permit:$ AA oav Square/Linear Footage of Work: rj
Type of Work: DAddition, Alteration ONewltepair/Replace ODemolition
Description of Work:• S .
Color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
I
TOTAL FEE NOW DUE$ U
V
Bonding'Company's Naie(if applicable)
Bonding�Companys Address
City State Zip
p,
Mortgage Lender's Name(if applicable) ,1
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 $25. 0, t pplicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure w' a ave ed to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commence t gnus a osted at the job site
for the first inspection which occurs seven (7) days after the buildifig permit is issued. Int abs nc ',o ch,posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Ih r
Signature ( Signature
d
Owner or Agent Contractor
The foregoing instrument was acknowle ged before me this The foregoing instrument was acknowledged before me this
day of _>20 Jam,by Pof day of 7i ,20by�LS 6!!{/n ,
who is personally known to me or as educe who is personally known to me or who . produced
A'g `d take an oath. tificati 'I and di e an oath.
Q ED
�� ' �0
0S (� WIN ARCC
NOTAI 176M NOT usu ,SATE
C MI I RID
(407)368-0193 XIS
Si Sign:
Print: Print: 11
My Co nn Expires: My Commission Expires:
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
YK V out`
Miami Shores Village j
a Building Department artment JUN 0 6 2013
10050 N.E.2nd Avenue,Miami Shores,
Florida 33138
t Tel: (305)795.2204 Fax:(305)756.8972 - - -—---
INSPECTION'S PHONE NUMBER:(305)762.4949
CALL-L-M
FBC 20
tlO
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.
Permit Type: BUILDING ROOFING
JOB ADDRESS: ��- /� 6ft;
City: Miami Shores County: Miami Dade Zip: 3�
Folio/Parcel#: I I — -Zt 3 m oygo
Is the Building Historically Designated:Yes NO Flood Zone: ►
OWNER:Name(Fee Simple Titleholder): ` �- '� 1 �«�hone#:
f C I
Address:
City: :!�VAState: r' Imo- Zip: 3.9(4211
Tenant/Lessee Name: N Phone#: /y f 4
Email: evekL laCSTN& TA;v
CONTRACTOR:Company Name:QVAQQa/ QW-1 AGT'o� SNC Phone#: 3os
Address: '90( NR- S7-
City: /'I r A M 1 State: Fe-'-a-" D Zip: 3 �13%
Qualifier Name: 91 Sft'b Phone#:
State Certification or Registration#: C G G (S!S S!a) Certificate of Competency#:
Contact Phone#: Email Address: t2So��(d vaea�GoNTe AcFopS•taut,
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ s S aoa Square/Linear Footage of Work:
Type of Work: DAddition -liI'Alteration ONew ORepair/Replace ❑Demolition
Description of Work: 1 N -re e L o F_. D Pic-i of 6 4 ,N mac✓ (e_&t,C�ble�J
T�Le r'�kTy�G CaW ('�ooR- !N-• K� tCNC'AJ, SNA l'dM��.� &-b-tA, Nervi
(nl i J1l ��W S •
Color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
N Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
1
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 m st be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the n e of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signatur �a-r Signature
Owner or Agent Contractor
The for oing instrument was acknowledged before me this The fore ing instrument was acknowledged before me this J
day of AC ,20�,by day of V It ,20/,b,by ,
who i personally known to me or who has produced �� w o is personally known me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUB C: NOTARY PUBLIC:
Sign ^ Sign: {//J
Print 0= ASTELLANO
My
My Co ,q. .°, hWCOMMISSION#FF001595
s1 > ll E. CASTELLANO
'= 'MY COMMISSION#FF001595 p„
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+ EXPIRES March 21,2017
(407)398-0
EXPIRES March 1,2017 153
FloridahlotaryServlce.aam
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APPROVED BY y Plans Examiner � v 7 Zoning 1
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
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