SGN-10-809 Sr7N Miami Shores Village TaUTS
Building Department MAY 10 2010
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax: (305)756.8972 ..,
INSPECTION'S PHONE NUMBER: (305)762.4949
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: BUILDING ROOFINs
G �`� 0
Owner's Name(Fee Simple Titleholder) cg�"a i4gk Phone# 3 — -6 Z,3 S
Owner's Address 9./erb
CitylJr State Zip
Tenant/1,essee Name Phone#
Email
Job Address(where the work is being done) 9e®c OAt�V6
City Miami Shores V/illaee County Miami-Dade Zip ,3:9
FOLIO/PARCEL# 0/ — `
Is Building Historically Designated YES NO Flood Zone
Contractor's Company Name /�K/1 (_1eW*a( XA Z4 �jj Phone# 3tos 033s Z�D�
Contractor's Address WW -.?4-fj�
City State Zip 3-4Z
Qualifier Name ee. W Phone# 30X-_ k,3; - 2 ev]
State Certificate or Registration No.6&L Sg& Certificate of Competency No. fop G> A-c,¢12
-Contact Phone E-mail
Architect/Engineer's Name(if applicable) .`. Phone'#
Value of Work For this Permit$ ��. �h 84hq`, /Linear Footage Of Work: ( �
Type of Work: ❑Addition ImAlteration ❑Neii ❑ Repair/Replace ❑Demolition
Describe Work: �
Submittal Fee$ Permit Fee$ CCF$ CO/CC.$
Notary$ Traiuing/Education Fee$ Technology Fee$
Scanning$ Radon$ DPBR$ Bond$
Double Fee$ Violation date:
Structural Review.$ Total Fee Now Due$
See Reverse side-�
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. 1 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
COMIVVIENCEENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS MNTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE. OF "NCEMENT."
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 certifled copy of the recorded notice of commencement must be posted at the fob 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 a reinspection fee will be charged..
Signature Signature
or Agent Contractor
The foreg mg rostrum F. was ackno Xbore me this The foregoing instrument was acknowledged before e this 74
day of ,2010, day of 20( by M
who is personally ka � �,l Z o ed who is personally known to me
P� V aic �� d iA o�
®A d who did take an oath. en � w ��d�tice ath.
NOT Y_ y. �A�° NOT
'3
Sign: Sign: 1pD�1
Print: Print: .�
My Commission Expires: 3l 2 My Commission Expires:
APPROVED BY Plans Examiner Zoning
Engineer Clerk checked
(Revised 07/10/07)(Revised 06/10/2009)