FW-07-1509Miami Shores Village I JUL 19 2007
Building Department BY. ____V_V________
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 -1 12,5)
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING PermitNo.
PERMIT APPLICATION Master Permit No.
FBC 2004
nBuildingPermitType (circle): \/ Roofing
Owner's Name (Fee Simple Titleholder) YX'4S Phone # lrb ;Z// 'IS
Owner's Address //) 6 // /?/ / / r 4 -
State F1----
Tenant/Lessee Name
Zip 7,3 /3 CI
Phone #
Job Address (where the work is being done) /dl
City Miami Shores Viltag County Miami -Dade
y
Zip
FOLIO/ PARCEL # .fir /ll/k c 6v t GSs/-7 f % . 0-0 14 CO
Is Building Historically Designated YES NO__V'_
Contractor's Company Name ow%l-S2 a— Phone #
Contractor's Address
City
Qualifier Name
State Certificate or Registration No.
Arch itect/Engineer's Name (if applicable)
Value of Work For this Permit $ 4
State
Type of Work: Additionjj Alteration
Describe Work: /ewi /_ 14_ ^ /V /
Zip
F# e No -
Phone#
Square / inear ootage Of Work: -z-0 C) 4_
New
I
Repair e l Demolition
1'YMry '
Submittal Fee $ Permit Fee $- CCF $ . 20 CO/CC
Notary $ Training/Education Fee $. Technology Fee $ J .cx::)
Scanning $
Bond $
Structural Review. $
Radon $
Code Enforcement $
DPBR $ Zoning $
Double Fee $
Total Fee Now Due $ - GC
See Reverse side —a
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 y pend tJat.,il woXl#vill beelfQrmedt 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 ( Ile
Owner Agent
The foregoing instrument was acl9owledged befo a me,this q %:
day of , 200, by ,
ywl
who is person lly known to me or who has produced l
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
PRI-
y/
MGN\G S\pNbe`2p?c
Print: /'UKICG ifit, `b°.GIQ\P NNo Ne.
My Commission Expires:
APPLICATION APPROVED
Revised 02108/06)
Signature
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:
a' My Commission Expires:
01
v
Plans Examiner
Engineer
Zoning