ACT-08-99260AA 0 6 , �
v�. Miami Shores Village
Building Department
YkDt`i,.o) G�V, 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
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BUILDING Permit No. ACTT
PERMIT APPLICATIO 11 1 2 2008 Master Permit No.
FBC 2004 -__ - ___-_
Permit Type (circle): Building Electrical Plumbing Mec anical Roofing
Owner's Name (Fee Simple Titleholder) f L Phone #
Owner's Address ` &
City ,[ ow �, [_p/j State J Zip
Tenant/Lessee Name
Phone #
Job Address (where the work is being done) :n5�: /—" -
City Miami Shores Villaee County Miami -Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES NO
Contractor's Company Name f a) k (' I — ''hone #
Contractor's Address
City State —zip
Qualifier Name _Phone #
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable)
}}___ ,��--��d G
Value of Work For this Permit $ -0 i' /�
Type of Work: ❑Additions ❑Alteration
Describe Work: I (�.�I�,1•_�x l
Submittal Fee $ Permit Fee $
Notary $ Training/Education Fee $
Scanning $ Radon $_
Bond $ T Code Enforcement $_
Structural Review. $
Phone #
Square / Linear Footage Of Work: Z Y IL( ?
❑ Demolition
-�
DPBR $
CCF $
Technology Fee $
Zoning $
Double Fee $-
Total Fee Now Due $
COICC
See Reverse side —>
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 note approveq* a reinspection fee will be charged.
or Agent
r
uu.
The foregoing instrument was acknowledged before me this 2
day of 20¢�, by �it?t1lL2Qr7/� -
who is erso� own to me or who has produced
p Y p
tl.tuw As identification and who did take an oath.
NOTARY PUBLIC:
Sign: _ ID u ?
Print:
My Commission Expires:
APPLICATION APPROVED BY:
(Revised 02/08/06)
11ROSA LUZ SANOOVAI
�;�. Notary PuttliC - Stale of Florida
.r My Commission Expires Jul 16, 2011
r aBUTh,o.0 Naional NotarvAm
Contractor
The foregoing instrument was acknowledged before me this
day of , 20 , by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Plans Examiner
Engineer
Zoning