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RC-06-983 Miami Shores Village F - ops ,a, A Building Department Bim. 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 !0 BUILDING Master Permit No?—W a - 9 83 PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ROOFING REVISION [:] EXTENSION E]RENEWAL ❑PLUMBING ❑ MECHANICAL [::]PUBLICWORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: AAJ City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: /Construction Type: C Flood Zone: BFE: (�FFE: OWNER:Name(Fee Simple TitlehoJ der): Phone#:y, l ,1/ . ? 1d j Address: /" l City: °?�• .5 '01'4e`f State: Zip:31?/40 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: lr- Phone#: Address: City: State: Zip: Qualifier Name: Phone#: State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration/ New Repair/Replace ❑ Demolition Description of Work: 5�� 4f v�• �"� 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) � ' t..r 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 ash an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and�jWruction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of thfeCT'lyded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the¢ it permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be,ch . Signature�� Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this ( � day of T' ��A� 20_ i �' ,by day of 20 .by 7exv - `who is p rsonall � y known to who is personally known to me or who has produced T�_ b7 f!K2- G. (M -% me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUB NOTARY PUBLIC: Sign: Sign: Print: S( Nt>LP AW Det, Print: Seal: Seal: ;o40 P*,#A Notary Public State of Florida Sindia Alvarez �Qa pMy Commission FF 156750 9031201#8 # * # #*##*#**###**#**##*#*****#*##*#*#***#*###******#*###*****# APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 1/3 7FEB ,7 Z01 BY: Miam Shores Villa e M �11B(0° 11 Building Department artment I©�10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305).795.2204 Fax:(305)756.8972 BUIL ING 1 2006 Permit No. P-00b PE T APPLICATION Master Permit No. FBC 204 B Y.- Permit ;Permit T*pe(circle): Csro� a.4 uilding Electrical Plumbing Mechanical Roofing � 1 � ' aJ "`"`��9� Owner's Name(Fee S�mp�e ) Phone# Owner's Address O t tAA City / %��.� CState Zip TeaantR.ese Namo Phone# �7t�-' ! % Job Address(where the work is being done) 7 /J W / 1 City Nfiami Shores a County . -Mimi- e zip- 3 :?fis t FOLIO/P, CEL# Is BuildingHistorically Designated YES NO Contractor;s Company Name rn(f Phone# Contractor's Address Cita' •Qualifier Name Phone# 1JL Al State Certi�cate or Registration No. Certifi petmcy No. ArchitectNAWeer's Name(if applicable) Phone# I Value of'Work For this Permit$ Square/Linear Footage Of Work: Type of Wdrk: OAddition 'Alteration ew, 0 Repair)Replace 0 Demolition Describe V ork: !t f, PAX" SAIX ow "' I iYa4drh�r 4r +YaY inTr drdr 4r sir 9r 4r4nY4r4nU9nir4MntrfrSe4r4r4nkdr4esr4ntnY9ntrintntntntntntr9rdntntrsnh4n4$nUtr- j Submittal Fee Permit Fee$ ''�.LU o± _ CCF$ ^...� CO/CC Notary$. - Traming/Education Fee$ ,C2 LO Technology Fee$ rJ' = t Scanning$f Radon$ DPBR$ zoning Bond$ ! Code Enforcement Double Fee$ :`Structural ew.,$ Total Fee Now Dae$ .Z •�� L . ..See Revirlea r r 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. Asa condition to the issuance of a building permit with an esttn ated 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 MOWr Signature '.1 Owner or Agent Contractor The f omg instrument was acknowledged before me ..,,.:The foregoing instrument was acknowledged before me this day oft- Ia 1 L,20(D�by�P day of .20 - by who is finally known to me or who has prat rC y known to me or who has produced ( d As identification and who did take an oath. as identification and who did take an oath. "NOTARY PUBUC NOMPUBLIC-SM OF FLORIDA NOTARY 'UBLIC:.46YborlepyHernaadez sd# 55 Sign: Sign: - Print: Print: . :My Co on Expires: INVMy Commission Expires: APPLICATION APPROVED BY: .. VSs Plans Examiner Engineer QY6 J J a Zoning Tk_n� :.. cb sA