FW-14-1740 Miami Shores Village cEnTED
Building Department 120'4
g p
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 2010 0�
BUILDING Master Permit No(A- ( 4-1� T()
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION RENEWAL
❑PLUM NG ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
`` CONTRACTOR DRAWINGS
m
JOB ADDRESS: 5q F_ 1C) t 14-
City: Miami Shores County: Miami Dade Zip: ��al
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: i' J l`/ /tj Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): ay, S r -Y'' k �
Phone#: S— 523o� cro
Address: -'!59 M (_ A I s st 1^^"b
City: 'in)QAMt' 51AZ-'S State: Zip: 33139
Tenant/Lessee Name: Phone#:
Email: CIC L ons _ V_Akirit Gi g (JaAo-,k,
CONTRACTOR:Company Name: ^�'�-�� Phone#:
Address: Own
City: State Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: (.i Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$
Square/Linear Footage of Work:
Type of Work: ❑ Addition 'M Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: FjA £ 1 61 a o� -74
�oo� Uf�i
Specify color of color thru tile:
Submittal Fee$ J00 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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before met oing instrument was acknowledged before me this
day of AQ-0� N ,20 LA ,by day of ,20 .by
OAOQ"� ICA CU rJ-0 SL"V$'s per';onally known to who is personally known to
me or who has produced r-k— C— 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:
13 g
Print
Seal. l
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
�5 Miami Shores Village
Building Department artment JUL 3 0 2013
0 '
Sv 10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
V INSPECTION'S PHONE NUMBER:(305)762.4949
` J FBC 20
BUILDING Permit No.
PERMIT APPLICATION Master Permit NoRF
Permit Type: BUILDING ROOFING
JOBADDRESS: (OZ3 gro-r'd Cas.^- C-Oars-4-
City Miami Shores County: Miami Dade Zip: 32?13 S
Folio/Parcel#:
Is the Building Historically Designated:Yes NO_ _ ,C Flood Zone: 9�5
) 2e � .-
OWNER:Name(Fee Simple Titleholder): r:� Phone#:�
Address: o ���-r, �.e.r� C p v r e-_
City: �l�,T42 -11,S State: �� ---Zip:
Tenartt/Les
ip:Tenant/Lessee Name: Phone#:
Email: Y`1rZ.. (v !2g.-( v
CONTRACTOR:Company Name: MIJ(DK �,,�J�S Phone#:
Address: I Cj c1 0-3 a)-e.
City: 19 1 jc/ / State: Zip: �/
19 Y
Qualifier Name: Phone#: 1 /
State Certification or Registration#: Certificate of Competency#:
Contact Phone#: Email Address:
DESIGNER:Architect/Engineer: Phone#:
a
Value of Work for this Permit:$ Square/Linear Footage of Work: C
Type of Work: ❑Addition ❑Alteration ❑New ,ZrRepair/nReplace 99 ❑Demolition
Description of Work:: "tea n 3--�1—
Color thra tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
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 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.
Signature Si4 ture
er or Agent Co cto 7��
The foregoing instrument was acknowledged before me this 2 7 The foregoM81720713by nt wcknowl for this},)/
day of ,20 D,by lLe "-P-�k- Z'e( �/� day of ,
who is tonally known to me or who has produced who i�perso y own o me or who r du
Al identification and who did take an oath. entification and w o did take an oath.
NOT YAP NOT AR UBLIC: -
Sign: Sign:
Print: d �L�l_�— � �-� Print: eAy oss%o(%# naiNota<y Assn
s <= ondebZhsou9
My Commission Expires. ,, s" NORMA HERRERA MY Commissi e
MY COMMISSION 0 EE205M98
EXPM3 39PWnbw 22,2016
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 5/2/2612x1;evised 3/12/2012)XRevised 06/10/2009)(Revised 3/15/09XRevised 7/10/2007)