ACT-06-1076 Miami Shores Village
Building Department
EB
10050 N.E.2nd Avenue, Miami Shores,Florida 33138 F
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 -`-'
FBC 20
BUILDING Master Permit No. �'�r- K- t
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS [:] CHANGE OF CANCELLATION ❑ SHOP
/J CONTRACTOR DRAWINGS
JOB ADDRESS: 7ZO/ 4`1 �"/q� r'�/9 / 4 ""
City: Miami Shores County: Miami Dade Zia:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder):�jkll Phone#:
Address: 97,1/ 4� /144/1/ '4
City: ��/� ✓`�i ��`/oi('i�s State: ISL- Zip: ?
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Phone#:
Address: '
City: Stater Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificat f Comency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 2(�O °d Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Re lace
p ❑ Demolition
Description of Work: /� L"/� P/-)op-7- /y—/r=,+
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 ' ' ,W
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.
Signatures ✓ l.z� �� ' Signature
OWNER or AG&"
`4 CONTRACTOR
The foregoing insttu-ment was ackno &d befor�.p�'this The foregoing instrument was acknowledged before me this
day of �`�� 2<�,�'
-' by day of ,20 , by
�
wl ersonally known to ,who is personally known to
me or who has produced G 'J`as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBi NOTARY PUBLIC:
Sign: Sign:
Print: 1` a tJ! `� � Print:
Seal: Seal:
�W-Y°i4, Noiary F'uf-)lic State o;Florida
M1 m o Sindra Alvarez
hAy r umrmssior FF 156750
Expires 09N0312018
Al
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
tp 14,
st
37 "
FEB 1 2016
.. ... . . . . . ..
• •• • • • • ••• •
• • • • • • • •
.• • • • • •
••• • • • • ••• • •
Miami Shores Village T Z-5 *scw_
• Building Department rn5
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 icl)
Tel: (305)795.2204 Fax:(305)756.8972 I0�
BUILDING "WM Permit NO.-IGT C� 0-
PERMIT APPLICATION R 6 2000 Master Permit No.
FBC 2004
Permit Type(circle): Building Elecitri al Plumb' g Mechanical Roofing
Owner's Name(Fee Simple Titlehol er) -� one#
Owne 's Ad s
City S e � Zip �g ���
Tenan ssee Name Phone#
Job Address(where the work is being done) '�'"[ a4e
City Miami Shores Villaize County . Miami-Dade a Zip
FOLIO/PARCEL#
Is Building Historically Designated YES NO__CO �� ��. — l
Contractor's Company Name 4F Phone# 30!5--,
Contrac Addres
City S Zip
Qualifier Name `` C;P1ae#
State Certificate or Registration No. Certificate of Competency No.�A S 3
Architect/Engineer's Name(if applicable) (910 AaY4APhone,# 1�'
Value of Work For this Permit$ / 'T S uare/Liwear Foota ee.Of Wt rk: 1
,9 g
Type of Work: ❑Addition ❑Alteratio ew A [-I Repair/Replace El Demolition
Describe Work: ®/� 4X d°k 40 &X7q
Submittal Fee$ Permit Fee 19 CCF$ CO/CC
Notary$ J• CC Training/Education Fee$ Q - Technology Fee$ Z • -
Scanning$ 6::, -CC) Radon$ DPBR$ Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ -5 eO Total Fee Now Due$ 1
ID
See Reverse side a
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 BEFt(6 RECORDING YOUR NOTICE OF
COMMENCEMENT." � �'
Notice to Applicant. As a condition to the issuance of a building rn- it with,an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement qoS construction lie bro hure will beldelivered to the person
whose property is subject to attachment. Also, a cer d copy of the'recorded notic of c m n'ceme t m be posted at the job .rite
for the first inspection which occurs seven (7) d4 s/after the building permit is 'sued. I the ab ce of such posted nwice, the
inspection will not be approved and a reinspecti f e will be charged.
ZSignature Signature _
Owner or Agent ontractor
The foregoing instrument was acknowledged before me bp
The:oXoing instrument as acknowledged before me this ZCo
day of , p�,20(3 b6 Htylo rt 14 - by , day g�L ,2(��byA C-�.J.
who is personally known to me or who has produced Gl who is pers nally known to me or who has produced
R• NIV* t "QA`s i entificatio fl1__ as identification and who did take an oath.
NOTARY PUBLIC: CoffeW G00222822 NOTARY PUBLIC:
OTA" ktre
TE OF FLORIDA
w Barad fru(000)324254$
Sign:
®f NomyAam,tw s Sign- He
Sl �9 `ISi n
Print: r V�.-nL Print: B n ed2XC
�9
My Commission Expires: I ��- I ` My Co ' sion Exp' .
APPLICATION APPROVED BY: ( �O yG�a G kG Plans Examiner
Engineer
rr 44
�+ Zoning
(Revised 02/08/0 0-6 S q
4e ,
�/��