CC-14-927 (2) F,
Miami Shores Village I MAY 242016
Building Department:
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
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OFCANCELLATION F-1SHOP
_ CONTRACTOR DRAWINGS
JOB ADDRESS: " 1(1! of j 17-" d A V
City: Miami Shores County: Miami Dade Zio: 3 3 l 3
Folio/Parcel#: is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: B.FE: FFE: a.
,� y S
OWNER:Name(Fee Simple Titleholder): Phone#,� '
Address: C M
-
City: k5'ae' .ti State:
Tenant/Lessee Name: Gtn.�M' �t �'�-� / Phon J
Email: V-'AC-\A AA,09 ` &-fC-,,
CONTRACTOR:Company Name: t��r� �`�. wl,f Phone#: J l� C, t
Address -q )�_ T, \0
City: kI'410VAA7 Sta `�- - Zip: 322 ( ,
Qualifier Name: Phone#:
State Certification or Registration M _�*Cate of Competency M
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Foota of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: + t dd
1'!
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$
(Rev1sed02/24/2014)
� 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 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-srtblect-t so;a certifiedcopy of theTecarded-noticea�commencement7rmst-ft pos e�`th-elab 91M - --
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 k, }- CONTRACTOR
The foregoing instrument was acknowledged before in thisaforegoing instrument was acknowledged before me this
-day of a 20 day of 20 by
1 o is personally knowW who is personally known to
me or who ha produced 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: v Sign:
e
Print: A' IPrint:
Seal: fl/r,,u �1 Seal:
N Nlr 4r. �RI I IN61W1\
MY 00WASSIOd 4 FF 084212
€ EXPIRES:December 14,2017
TfwNot�yPub6cUMens
###########################################################
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Rev1sed02/24/2014)
MTC
miami theater center
Village of Miami Shores
10050 NE 2nd Ave
Miami Shores, FL 33138
May 24, 2016
To Whom It May Concern:
Please arrange to close out the following open permit on our behalf:
• CC 14927
We are unable to perform the work at this time due to time constraints. We will reapply for the
permit once we have the necessary time available to complete the project.
Sincerely,
Elai Irizarry
Exec tive Dir for
9806 NE 2"d Avenue,Miami Shores,FL 33138 0 Phone:305-751-9550 0 Fax:305-751-9556 ■ info@mtcmiami.org ■ www.mtcmiami.org
r%4 T C
miami theater center
Village of Miami Shores
10050 NE 2nd Ave
Miami Shores, FL 33138
May 24, 2016
To Whom It May Concern:
Please arrange to close out the following open permit on our behalf:
• ELC 141101
We are unable to perform the work at this time due to time constraints. We will reapply for the
permit once we have the necessary time available to complete the project.
Sincerely,
Elairtive
ry
Execir ctor
9806 NE 2'd Avenue,Miami Shores,FL 33138 0 Phone:305-751-9550 0 Fax:305-751-9556 ■ info@mtcmiami.org 0 www.mtcmiami.org