CC-12-2340Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BU LDING Permit No,
PERMIT APPLICATION
Permit Type: BUILDING
JAN
2014
Master Permit NoCC. 12 - 2.&L/i0
ROOFING
JOB ADDRESS: qic �� h L, I
City: Miami Shores County: Miami Dade Zip: 1213
Folio/Parcel#:
Is the Building historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple
City:
LLA
_Phone#:
sre'5. �L
State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Address:
City: State:
Qualifier Name:
State Certification or Registration #: ��E't k7_- cl �� Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
9[54 jag 34S`7
Value of Work for this Permit: $Square/Linear Footage of Work:
Type of Work: ❑Addition ❑Alteration ❑New ❑Repair/Replace ❑Demolition
Description of Work: en eC�t�ci1 � � � P r 14-
Color
4
Submittal Fee
Scanning Fee $
Color thru tile:
Permit Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $
CO/CC $
DBPR $ Bond
Technology Fee $
TOTAL FEE NOW DUE $ 153 dC7 '
i
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
city
State
zip
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 ELECTRICAL WORK, PLUMBING SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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. / ="vs,° ®.� A �J sg � ,..� �, Signature
Ll
Owner r Agent, Contractor
The fore omg instrument w s acknowledged before me y ore oing instrument ways knowledged before me this
day, 20 by hd ¢ ' , 20�(`/ , byr�'�
who ieper!oUna�11��own to me or who has produced who is perso ally loiown to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
SiYn:lflJ !®l _ � ' . k�JL N'" � Sian 9
Print: :4 4z�-Oz L� Print' i�� Ibr
My Commission Exp' a�'N PALIA DAWN IEE' ADAMS My Commission Ex ��res: ° � 30 l,�
�* MYCOMMIS "#EE 126691 ;�0 PAULA DAWN LEE ADAMS
'Q EXPIRES: August 30, 2015 * MY COMMMION # EE 126587
BMW OFFjp0. TWB Pserv� * EXPIRES: August 30, 2015
or fu
APPROVED BY
Plans Examiner
Structural Review
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
Zoning
Clerk
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER- (SMS) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: Electrical
1 20121
FBC 20
Permit No. I�J�
Master Permit No.
JOB ADDRESS: ql fes% -1 a
Y iI R-- /v
City: Miami Shores
County:
Miami Dade
Folio/Parcel#: 0 3
Is the Building Historically Designated: Yes
NO
X Flood Zone:
OWNER: Name (Fee Simple Titleholder): / /
I'l e -f
Address: �?I d
J �
f.
City: I 7dW I SO4,e a`s
State-.. Fl.�
Zip:
Tenantd,essee Name: c ,�
�� "� i c_ -
Phone#
Email:
CONTRACTOR: Company Name, 4 4
® / "" G
i
Address: a'? S7 S
�y�
City: , l /* to rrt !
State
r
/ Zip: 3I g -
Qualifier Name: VV e$ -M
r IJ �e a"!e
bone#: 30S7„z a 3
State Certification or Registration #: f— C 13012
199.
Certifi o patency #
Contact Phone*9S—"/ R,05' 6 94 a
Email Address:
DESIGNER: ArchitectlFatgine ..-- / s7
i 11 rl�3 I1
r s � ,Phone#:
Value of Work for this Permit: $ Squareli ineor Footage of Work:
Submittal Fee $ Permit Fee $ &/1 ®e g-� CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Educadon Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
t
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Tap
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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.
1 'fdi01` • 0!�'101,—�v��►t���7�,�,,�.•��— 1 . 1
�1/J���-r-_
-CONSULT WITH YOUR LENDER TTORNEY BEFORE
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 budding permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged
Sin�'-
Owner or Agent Contractor
The for oing instrument was acknowledged before me this m The foregoing ' nt was acknow,l�� before me tbisa4
day ofv 2 20 f Z-, by�d P �J day of Cl:dY 20 !Z , by /VeSd� �0 rVQu
who is pfrsonall� to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sip:
Print: - -
who is asnAo x or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Francisco P. Morales
Sign:74 /�! Public - state of Florida
Print4�r h S to - aslon# ® 9134532013
ling Co. Inc.
Structural Review
(Revised 3/12/2012)(Revisa107/10/07)(Revised 06/10/2009)(Revised 3115/09)
Clerk