SGN-06-2271 M1aYn1 Shores Village p �� 'M
BuildingDe arfinent s 2006
(A� 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 B Y_KKI�'.....
Tel;(305)795.2204 Fag;(30S)756.8972 -
BUILDING Permit No.`. off"Z l
PERMIT APPLICATION Mater Permit No.
FBC 2004
Permit Type(circl Buil7j� lectrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple - Og = Vt&LA&C.�LLC Phone#����J zipj Y a'
(]Wner'S Addre33 272 B g SCAt &' O 7
jr 3 t•t
City r i Af4 State T L" _ Zip
. TenaoMessee Name CA A, e qA-M e Lr-_0 N Phone#
Job Address(where the work is being done) '�M q 5 Aof--gy
City Miami Shores Villaie County - Zip
FULIO/PARCEL#
i
lsi Building Historically Designa YES No
Contractor's Company Name T .V Phone#(3 D�� 95 7- 57019
CQntracto,(r,'�S Address �� p r
City / �"! ' ; 'U0 �S State for T Cly/ zip
Q;"er Nam one#
State Certifi or Registration No..AC O?► 90 CerEificate No.
if applicable)
Ph
i, #) 1 #
Archi ' eces Name
Value of Work For this Permit$ FOO <i O49 Square/Linear Footage Of Works
Type of Works .❑Addition ❑Alterakion z4ow, ❑ Repair/Replace' ❑Demolition
Describe Work:
a
Submittal Fee$ Permit Fee$
Submittal � CCF$ CO/CC
Notary$ Training/Education Fee$ Technology Fee$
Scanning$ Radon$ DPBR$ Zoning$
Bond$ Code Enforcement$ Double Pee$
Structural Review.$ Total Fee Now Due$ LGt4„!
See Reverse side
22FND .
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
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 acairate and that all work will be done in compliance with aff
applicable laws regulating mon and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEM12M TO YOUR PROPERTY. IF YOU INTEND TO OBTAINFINANCING,
CONSULT WITS YOUR LENDER' OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a budding permit with an estimated value ezcca tg 1 500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure-wddl b�delivered to the person
whose properly 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 a issued ln<O sence of such posted notice, the
inspection will not be approved arjA rrfionfee will be charged
x
Signature f �� S
NOVI
Contractor
The forego wJ acknowledged before me The foregoing instrtnnent was acknowledged beforeme this
day of 20 0rc by 9 UbC)Jj K day of 200(4,by
who is me or who has prob ed who is me or who has produced
As identification and who did take an oath. as identification and who did take an oath
NOTARY PUBLIC: NOTARY PUBLIC:.
Sign: Sign:
MIt M PEOROSA
Print Print: r4lh 'ON A00062985
My Commission Expires: W rounatsstO a nnaas2 MY Codon ExPIREs:ocr 29,2007
• WIRES.arc 09.2=
APPLICATION APPROVED BY: Plans ExaminerWV .
6zming
t0210&"
S�OR,Is ANNING AND ZONING BOARD
OWNER AFFIDAVIT
u� nenM
as Owners?ofd
Section r plat Book&Page (the:Subject Property)
located at_ �i �S' (�. ��. G ��l dem to file an application for a public bearing before the
Planning and Zoning Board and Uwe understand and agree with thefopowfng:
1• The application for a variance will not be heard unless the spplic ent is present at the hearing.
2. Requirements of the zoning code.Mlaml-Dade County.the South Florida Building fie.and other government agencies
may affect the scheduling and ability to obtainbsue a parmit for the proposal
3. The only exceptions to the zoning code arc those that have been specked in the written applicallort,and any other code
or plan Issues will be corrected.by niodifying the plans to comply-with the respective codes and ordinances of the Village.
4 The applicant wig be Eton with the �with all-of the conditions and restriWans Imposed by the Planning and
by the Board.Zoning Board In �uest and will talcs the necessary steps b.make ftrequest effective If approved
5 That it is the responsibility of the applicant b•subrr>ft.a - -- -
Planning sand Zoning Board b hear the appkanrs request appticaffon with all of the documents necessary far the
B. The applicant Is resporrsible for the timely submission and accuracy of all items requested on the application.
NOTE: SURVEYS, SITE-DEVELOPMENT_ PLANS, LANDSCAPE PLANS MUST BE SUBMI iTED AT
STANDARD. PLAW SIZE.' AN APPLICA QNSID�RED'COMPC:EI'E UNLESS a0'
COPIES OF THE APPROPRIATE PLAN D tTTEE?WIrH PROPERTY SURVEYS.
I!We as the owners of the subject property:(Please check one)
Q Do hereby authorize to act on my/our behalf as the
applicant
0 Will on my/our awn behalf act as applicant(s),and make application to cxnnectiort with this request for a
the Planning and Zoning Board, public hearing before
1/We understand that if my/our appeal is denied. Uwe may appeal the decsion of the Planning and Zoning Board within
(10)days to the Village CounclL.
STATE OF FL OF DADS STATE OF FLORIDA.COUNTY OF DADE
Signa f Owners
Signature of-Applicant(if different Emm Owner)
t N a)
�j Print Narita
Sworn Jo and subscribed before cru this 2° ` day of.�V�� Swam to and Srtacribed before me this day of'
Signature of Noi
bile jil'AYBO
• to Signature ofNotary Pttbik•State of Florida
SEAL: MY N#DD345243 SEAL:t ��ARY flsaoG
Personalty Imo n �P.ersonally known OR Produced Identification
Type of Identification Produced: .Type of ideatitkation Parfmed: