REV-16-1690 �= Miami Shores Village - '
Building Department JUN 17 2016
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION UNE PHONE NUMBER:(305)762-4949
FBC 2014 541A
BUILDING Master Permit No.13PP16-202
PERMIT APPLICATION Sub Permit No. Q6U L 6- i r0q0
❑BUILDING ❑ELECTRIC ❑ ROOFING ON REVISION ❑EXTENSION []RENEWAL
PLUMBING ❑MECHANICAL ❑PUBLICWORKS ® CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 549 NE 95 St
City: Miami Shores County: Miami Dade Zin:
Folio/Parcel#:11-3208-014-0740 is the Building Historically Designated:Yes NO
Occupency Type: Lead: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):John Rossetti Phone#:786-301-1057
Address:549 NE 95 St
City: Miami Shores State. FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email: A
CONTRACTOR:Company Name: Parkwood Pools Inc Phone#: 786-301-1057
Address. 6761 W SUnrise Slyd
City: Plantation State: FL Zip: 33313
Qualifier Name: David Adams Phone#: 788-301-1057
State Certification or Registration#: CPC1457879 Certificate of Competency#:
DESIGNER:Architect/Engineer: /u Phone#:
Address, A City: State: Zip:
Value of Work for this Permit:$0 r - Square/Unear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Revision to add paver decking and remove planters AaD SW Sc p F
�Q.CIG
Speeft color of color ON 01
Submittal Fee$ - - _ Permit Fee$....� ®® - CCF$ b Oma,- CO/CC$
Scanning Fee$ Radon Fee$ U DBPR$ Notary$ n
Technology Fee$ Training/Education Fee$ 0 . 2-o Double Fee$ �
Structural Reviews 0 'Bond$ i/J
TOTA4 FEE NOW DUE$ Ys°--
(Rev1sed02/24/2014)
k
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. 1 understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES,BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC.....
OWNEWS 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 pasted 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
&LQSignature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
14 day of June 20 16 .by day of June 20 16 by
John Rossetti who is personally known to David Adams ,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: NTHYA COPLIN Print:
Seal 'COMMISSION#FF245967 b(4O
HYA CCII�LIN
EXPIRES duty 20,2449 Seal: Ml'COMMISSION#FF245967
,i,5 i vamrysmwbce cam R:;, EXPIRES July 20.2449
3`+3 0153
Fa+ideNaaryS®Ice
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APPROVED BY Plans rreh zoning
Li
Structural Review Clerk
(Revised02/24/2014)