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WS-13-2304 CL2013 Miami Shores ores Villa ge OCT Building Department By: a) 90050 N.E.2nd Avenue,Miami Shores,Florida 33138 S Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 FBc 2010BUILDING Permit No. PERMIT APPLICATION CANCELLEr Permit N.Sp, I -/ Permit r BUILDING ROOFING JOB ADD City: Miami Shores County: Mani Dade 75p: �j J Folio/Parcel#: ' o— 00-116 Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee/Simple Titleholder): _ y"( May sI') phone#: Address: I V City: w11 .7 State: Zip: TenanvLessee Name: Phone#: Email: CONTRACTOR:Company Name: U VV Gh f 40,ne#: U i y� 3Q� Address: � © � Q City: 1 ou State: L Zip: 3 3 3 Qualifier Name: to W OVA 0 Phone#:—9-13326f State Certification or Registration#:_Gc9G ificate of Com cy#: Contact Phone#: '16u 111 Z G 1 7 G Email Address: �Jt° V� v4 q DESIGNER:Architect/Engineer: Co Phone#: G Value of Work for this Permit:$ J.dy SquareUnear Footage of Work: Type of Work: OAddition DAlteration ONew ORepair/Replace ODemolition Description of Work: xrA cx I Color thru tile: ***««*«**«*«*******>R**««*«*****«**«****pees*«*««***«************«*«**««****««*******«** Submittal Fee$ Permit Fee$ CCF$ COICC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ &Met=[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 zip Application is hereby made to obtain a pemdt 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 attaci,,:nt. Also, u 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. a ne ol such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature Signature Ownero t ontraetor instrument was acknowledged before me this The for i i strument w s ekno=gbefore me is 7 d— �l :... 2 day of 20 by i ally own to me or who as produced who' rsonaUy known me or who has produced 81 entification and who did take an oath. as Identification and who did take an NOTARY P Sign: Print. ta; �� - Print: S10 My Commission Expires: My Commission Expires: Z y o bw APPROVED BY Plans Examiner Zomn Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06110/2009)(Revised 3/15/09)