DET-15-2730 moo Miami Shores Village
Building Department
JUN 1120 6
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 - -
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC201�
BUILDING Master Permit No. 1T
0
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: -ll1 i qt5 5[—
City: Miami Shores County: Miami Dade Zip: �27 30B
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
(/ ' / '1 s
OWNER:Name(Fee Simple Titleholder): 15 LQ VAC, Phone#: 2ap-d-W-5_5
Address:
,�aRU fqC a� ,5�
u�'l —
City: (Alq t 5 State: FL_ Zip:
Tenant/Lessee Name: Phone#:
Email: t , �Wqr_6) 4Y1C;c[ l co VVI
CONTRACTOR:Company Name: 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: C� Com` L- ��SL L� �f,_l 1 S—Z3-70
V _0-(Z� t�fl� sa1 — .
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
City State Zip
Mortgage Lender's Name(if applicable)
ortgage Lender's Address
'� a 1 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 occur 7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved d ins a ren fee will be charged.
Signature Signature
OWN CONTRACTOR
The foregoing instrument was acknowledged before me T(,eqfgr� ging instrument was acknowledged before me this
0 '
I
day of 20 C b u�4 ±ay of ,20 , by
who is personally known to ,who is personally known to
me or who has 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: Sign:
Print: Print:
Seal: Seal:
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Miami Shores Village _TvFFD
� ,6� BuildingDepartment SEQ172015 10050 N.E.2nd Avenue,MiamShores, Florida 33138 BY
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 ►C/
BUILDING Master Permit No.wyT ) 5=
PERMIT APPLICATION Sub Permit No.
�X' BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
F-1 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
�( CONTRACTOR DRAWINGS
JOB ADDRESS: `ti� go
Ci : Miami Shores Coun : Aw, Miami Dade Zi 1 '�F'
Folio/Parcel#://— 32 OC P o® ' —44z r f) Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: done: BFE: FFE:
J 1/ � .,�Y\1A C— Phone#: Q T-
OWNER: Name(Fee Simple Titleholder):&CL(� C.-' 1_ C.1)-�3d-S 34)
Address: )(90 oe gn Si
City: A M1 sitc(dE-s State: Zip: 3-7I 33
Tenant/Lessee Name: bi/A ,, ) � Phone#:
Email: G !� d►►✓ r Lu.
CONTRACTOR:Company Name: y \�� Phone#:
j
Address:
City: State Zip:
Qualifier Name: Phone#:
State Certification or Registra ' Certificate of Competency#:
DESIGNER:Archi ngineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: ®L? Square/Linear Footage of Work:.
Type of Work: ❑ Addition—❑ Alteration gNew ❑ Repair/Replace ❑ Demolition
Description of Work: `
Specify color of color thru tile: ODD 0
Submittal Fee$ 1566 C)Co 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 FAILURET ORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FO ENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSU l SUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMY:''
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 spection f lb charged.
b
Signature -Signature
O"'br/AGE�T CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
1T day of _S15 43&-�ee ,20 /9 by day of ,20 by
61 Seffe ��® irc2C who is personally known to who is personally known to
me or who has 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:
Si • Sign:
F
Print: a Print:
Notan M a-WFeliciano
Seal: Jp C � pF OSV53 Seal:
�,c�� Mxpitea 0111212018
OWF
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)