REV-16-1502 Miami Shores Village RECEIVE
0 T 2 8 2016
Building Department BY: '
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 S
BUILDING Master Permit NO, I G 3199
PERMIT APPLICATION Sub Permit NO. ET—V IC-1562-
UILDING L] ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [] CHANGE OFCANCELLATION � SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zig): 3 J13
Folio/Parcel#: s the Building Historically Designated:Yes NO ;3,"I"' _
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): ri n0 C%k i C, Phone#: 0,5k4 ° us !.-Zorjq
Address:
City: M r�,rr�e S�1Dfc�S State: Zip: 31
Tenant/Lessee Name: 41- Phone#:
qW
Email:
CONTRACTOR:Company Name: pAPhone#:
Address:
City: State: r L� Zip: 3_�>11Z)z
Qualifier Name: 6,l--. ®,®CIV<-A eo Phone#:
State Certification or Registration#: C=am 14`� ZiCA Certificate of Competency#:
DESIGNER:Architect/Engineer: -}_.MI ,0 OU)ZLl)it Phone#: —My
•1 ► ,�,="1 1�
Address: *5 1-1 5L -1N&R_ City: State:4"-L. Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ` G
.'1 , II ElElRepair/Replace Demolition
Description of Work: 0 ����l Q6 OF tO f)
Specify color of color thru tile:
Submittal Fee$ P 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)
i
Bonding Company's Name(if applicable) Pk
Bonding Company's Address s�
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address i. r®
City State Zip
p
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 estimated value exceeding$1500, the applicant must
promise in good faith that a copy of the notice of commen NdRIERNMcdon lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certi ' corded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days r 'guiding permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee be charged.
Signature -77;> Signature _
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
3® day of 20 ,by --::3 _day of ,20 it.., ,by
'R"rL\ �Ili , ,who rsonally known t..l',rt 1 11c� etc ,who is sonall I known t.
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: —4iw,03 Sign: /Zl
Print: ICL.,- t-)nc--? Print:
- ' ' Seal: P6� MARCOS A,MARTINEZ
Seal: y ._- MY COMUSSION#FF 008989
�- -----
KJ8989 EXPIRES;Arley 15,20-1
?017
Bondcd Thru Notary Public Undenvi'ers
�A#�BW9��k6uk+Ri�k�M � �k +k#�R�R�k�9�kW�B�&Maki�N�MbW6�kkkA�S+6�k�Rt�3i�4• �YB+k�RMeS&tisk#�M8
MY COMMISSION#FF 008989
APPROVED BY �` EXPIRES:May 15,2017
,,, goaernriters Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Miami Shores Village
Building Department JUN 012016
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. ew- t2-1S-3�q g
PERMIT APPLICATION Sub Permit No/aa _ L.202-.-�
EBUILDING ❑ ELECTRIC ❑ ROOFING •❑'REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [] CHANGE OF ❑ CANCELLATION [-] SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 55 t1j E: C1111 5t.
City: Miami Shores County: Miami Dade zip: `6
Folio/Parcel#: I 1 -3 2 C)(c 13 . ®9-2 C) Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):_s nC ►����c�eL t �— Phone#: 9 SL4 • G 3 y-J-0 7
Address: J :41r
City: U A C'-'-- a 3�y'(-PS State- Flo ` Zip: J' 139
Tenant/Lessee Name: 'tj Phone#:
Email:
CONTRACTOR:Company Name: P'�r"ej Phone#: C)
Address: �)---�C)C) IQcti3 -?,5- _S t . 4r t 1)
City: 60-z'( State: FL Zip:
Qualifier Name:Name: �(��+i.oc__ �'�r--e,. C- Phone#: •'7 7? 0
State Certification or Registration#: 0 PC,!q Rc�?®4 Certificate of Competency#:
DESIGNER:Architect/Engineer: /s Co:YW Phone#: "�8Cv �1 I S- -1/
Address: i -r ScA9 14";1 'AN City: !-4;C ant State:FL.. Zip:
Value of Work for this Permit:$ 1`�n® o Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:&C.V. ..4e Gj �j -4=r-�-
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)
4
a
Bonding Company's Name(if applicable) YJ 4A
Bonding Company's Address /)/A
City State Zip
Mortgage Lender's Name(if applicable) _T¢
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.
Signatures Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
3 day of 20 1 U ,by 31 day of 20((.o .by
.L flci r , r who is rsonally know o �1. C� ,who ersonally known
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:
r
Sign: �✓
4r"Sop MARCOS A.MARN
Print: !✓1 cr'e c�S �I :gin .= PW1Ph1:0
EXPIRES:Ma f 15,?017
Seal: ge6:Thru Notary Pubiic r.3--srai:;ae::_—:.�—_.n.
%-%JT1 4FZ -- MARCO9 A FAAy11rJ
_. a4.
My CTI
My CGMMISS B9
�= EXPIR=ES v U I/ EXPIRED W: tI
BondrdTh.uNioteryF,. ;UnJeRriter i
s Bonded Thru Notanj Puui,c Undewiters
>keK*>K6tlrsNrkk*rki &kk#k>k*FkR4Yrkffi>kbcrk***>Mrk>k& **rk>R+N+krlrMk+k
i
APPROVED BY fy r� Plans Examiner �l G Zoning
Structural Review Clerk
(Revised02/24/2014)