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RC-14-1624 (4) iami Shores Village ild,ing Department F B 11 2016 50 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 201` BUILDING Master Permit No.�C PERMIT APPLICATION Sub Permit No.PQ-\ 16 '�®1 BUILDING ❑ ELECTRIC ❑ ROOFING g/REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: "$- City: Miami Shores County: Miami Dade ZID: 3 2 118 Folio/Parcel#: (— -3 Z aS�^ 1)< 03M-�J) Is the Building Historically Designated:Yes NOy/ OccupancyType:s, ��P'1Load: Construction Type: 613u Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): f#([I L /'b�L-� d Phone#Ho 7 cf/b 37612 Address: 10 3 'X VV 'I S City:VA I A,&: S JA-r—S State: L Zip: (3 Tenant/Lessee Name: Phone#: Email CONTRACTOR:Company Name: C CO-A3~ Ct( d Phone#: 732l Addresses: 3 � City: M I Alt, J KCA� S State: Zip: 3 -3 ( 3 Qualifier Name: Phone#: S A 016e StateCertification or Registration#: c 3 ( 19 Ik Certificate of Competency#: DESIGNER:Architect/Engineer. N D <. k-Pdt l t 10 Phone#: T&ii N 2 Address: Q)1) S W � � � (, City: C tate:_J�L Zip: 534' Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace El Demolition Description of Work: tWc-e-� jB o-rc-L 1211 U ,k AS i-i `- 06-4 Specify color of color thrc ."tele: Submittal Fee$ , Permit Fee$ CCF$ CO/CC$ Scanning Fee$ ci� 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. in the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature-al� Signature Avom-� 9'44'C4 OWNER or AGENT CONTRACTO The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 ,by (7p day of by n�&a ( C1 CA:�4=who is personally known to w oi rsonally know me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign Sign: Print: Print: Z Seal: Hem m Seal: �.►e► NoW 7 POW Stdo Rodde Comm/FF125227 C Rodriguez UP 21, 2018 ` My Commtsaion MOWN 1AINAM.ANIMINOTARY.M a =4=016 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 1 � Pre-Construction elm Termite Treatment ' 7670 Okeechobee Blvd., West Palm Beach, F1. 33411 Phone: 1-800-285-7378 Fax: 561-684-0122 Traperty Information Builder/Contractor Treatme$t Tate H ' S Time - ,- -aft" Lot Block Name of Auilder Subdivision Name Shell Contractor Street Address(If known) Construction Type City State zip []Monolithic W oating/Stemwall Matio Owner's Name (If known) ©Entry ClDriveway DOther: Product/Treatment Information Treatment Type: . Underslab ❑Patio/Driveway/Entry 0 Final Wood Treatment ❑Bait System ❑Other Product: ❑Disodiuim 4ctab6rate ❑Cypermethrin O Imidacloprid O B' nthein ❑Permethrin C Other: Concentration Q.0(e Mixed Product Applied Square Feet Treated 12— Linear Feet Treated 0 If this box is checked, then Final Perimeter treatment has been completed and the following.statement is applicable: Certificate of Compliance: This,building has received a complete treatment for the prevention of subterranean termites. This treatment is in accordance with the laws and rules established by the Florida Department of Agriculture and Consumer Services. Applicator's Name (please print) Applicator's Signature HES-TE019 06113 Hulett Environmental Services©2013 � \ Miami Shores Village .r� Building Department NOV 12 2015 10050 N.E.2nd Avenue . ' , onda 33138 5-22 5 5 972 E AW NIFIRMU )762-4949 FBC 20 LO BUILDING Master Permit No. f2-e--1 `4 1 (.O Zy PERMIT APPLICATION Sub Permit No. BUILDING ELECTRIC ❑ ROOFING tKREVISION ❑ EXTENSION ❑RENEWAL F-1 PLUMBING ❑ MECHANICAL ❑PUBLICWORKS ❑ CHANGE OF [] CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 3A � S &1~i;..7 City Miami Shores County Miami Dade Zip: 331:52 Folio/Parcels.-_U3205-01a03210 Is the Building Historically Designated:Yes NO Occupancy Type:S�Load:4W Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 10 3'A N G-9'� S'it t� +.. Phone#:&0 Z1` 6"5l Address: / 0 -32. N L` SIS S %621=13--I City: /1/I .f+ A4 i S f� d(2"-Z State: — Zip: 3 3( ' Tenant/Lessee Name. Phone#: Email: o CONTRACTOR:Company Name: A C Phone#i���6 Address: C dam--► ! City:j*.4 M - �5 6LCVZ:j�.S State: C. Zip: /-3 Qualifier Name: LA Phone#: 5 State Certification or Registration#: XC l-?Y/! !d Certificate of Competency#: DESIGNER://Architect/Engineer: :TAA '5t4�:�tAN k -201� EM p Phone#: t 3��' t3 3 Address: 4-)o 4w t` 7`15 ) City:F36t^-RAState: C Zip: Value of Work for this Permit:$ #D� Square/Linear Footage of Work: Type of Work: ❑ Addition 2 Alteration ❑ New ❑ Repair/Replace ❑ Demolition 137ription of Work: � a*( / U! &- l�® S w � �S C $ ' + 2 o0 Specify color f co or 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$ e (RevMdO2/24/2014) 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. in the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. nAu.Signature Signature OWNER or AGENT TRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 1'" ,20 J s .by /5-�h day of ®C l .20 / .by rwho is personally known to regorr �. �U�l J!,who is personally known to me or who has produce as mebr who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: Seal: COMA#FF125 Seal: "�P's MILDRED Y.GOMEZ '4"W'r. ,PR Le EXPIRE$: k* 21, 201$ '2ff" `°S Notary Public-state of Florida S- � WwwAARoNNOTARY.COM '• '�Q My Comm.Expires Aug 24,2017 Commission#FF 40660 APPROVED BY t Plans Examiner Zoning Structural Review Clerk (RevisedO2/24/2014)