RF-13-2173 'CEIVED
Miami Shores EP 2 2013
p� Village s s
Building Department BY: `
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20
BUILDING Permit No��J�
PERMIT APPLICATION Gkv�[-LLE&terpermitVELLE6 '
Permit Type: BUILDING ROOF
ING
JOB ADDRESS: S
City: Miami Shores Coun Mia de ----Zip:
Folio/Parcel#: ji, 213 - tom(/ —
Is the Building HistorleaVy Designated:Yes NO_ Flood Zone:
OWNER:Name(Fee Simple Titleholder):_ _tUJ e�`��' L7S k L P Phonc#: 3oS 421? 0464
Address:3250 ME 1S4 A"r ,'-i.l��•i r log' �g 3 313
City: State: Zip: 3 3 13 ,
Tenant/Lessee Name: Phone#;
Email:
CONTRACTOR:Company Name: ^� 2aCe��1 P.r>t l 'e-C iC S _ Phone#:, 6 2144
Address: I®o e- 6
State: �(_.
�. ��� � zip: 3
Qualifier Name: Phone#:
State Certification or Registration#: 132,9qilCertificate of Competency#:
Contact Phone#: Email Address:
DESIGNER:Architect/Engineer: Phone#:
Viilne of Work for this Permit:$ 4 ;�AnareJLinear Footage o 'York:
R
Type of Work: OAddition OAlteration qew� ORepair/Replace (Demolition
Dem iptlon of Work:
Cofor-thru
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ g Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
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
. r
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 P7da a reinspection fee will be charged.
Sign t/` Si ature
8n
Owner or Agent Contrac
The 1`o i g instrument was acknowledged before me this The foregoing instrument �asackn
� ledged before me this-4-9
day of� _ day of 4 20 Q by C t t
who i ersonally known to me or ltllducer� p
��i who's personal] known to me or
exa
s rden� *erm oath. en ti catioatft�iA►� airaa�i
NOT Y PUBLIC: _ �' �� ;g= NOTARY P LIC:
'� r
Sign: .` Sign:
Print v TApY pUB���'�� Print: V 0%.r//
My Commission Expires: I Z�11 My Commission Expires: f ��
1 �
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 3/1212012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/1S/09)