MC-07-2051BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: Mechanical
Owner's Name (Fee Simple Titleholder) i rz& ' ul i t JPC a r("`)
Owner's Address 11 S 00 (.(.E 2 •c M1E UOE
City (-1 ( M I SwopA S State
Tenant/Lessee Name
E -MAIL:
Submittal Fee $ Permit Fee $
90 .Miami Shores Village
aeenrr - Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Is Building Historically Designated YES NO
Type of Work: ❑Addition Iteration
Describe Work: 8 ifCer B-a
C
�}--t l 1-4
(`
•
❑New
Bond $ Code Enforcement $ Double Fee $
Master Permit No.CX,1 1C:6
Phone #
Zip 33(
Phone #
OCT omEW9
0 2 2001
BY:
Permit No.00jQ7'' a51
Job Address (where the work is being done) . t ?U A` I G (AB 20 IJ LA f 1 1 S' 44' . mz ,�,, r ,
City Miami Shores Village County Miami -Dade Zip 3 t( I
FOLIO / PARCEL #
Contractor's Company Name GOLTCC- I nJ' Li AJC.r . , Are_ Phone # C 2 SG 0 0 tf 6
Contractor's Address l 2( C ( 3 I /eJ 11 C
City M 1 1111 1 I State FL Zip . 3•116 , 6
Qualifier Name b A NUJ 1-C1.- OE L.-V/ -T Phone # C . 0 2 S" C c7 U Ce C,
State Certificate or Registration No. a ( C S ( 6 3 5 Certificate of Competency No.
E -MAIL: 0 5e t i14 e C. • LT e t-, c 1 At,/ —) i Ai t1 . e.,o r
Architect/Engineer's Name (if applicable) 4-I/} n P Phone #
22t
Value of Work For this Permit $ Square / Linear Footage Of Work:
❑ Repair /Replace ❑ Demolition
s'n L1 T S Le sT 5b-(
*********************************** IY** Ce eY ********eY*********** *dce**'**
eC)
4-40
Structural Review. $ Total Fee Now Due $
CCF $ 1?) J .?� CO /CC
Technology Fee $ 1(19 .5O
Notary $ Training /Education Fee $
Scanning $ . Vv Radon $ DPBR $ Zoning $
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. 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."
Jar time j1rsi inspection wnten oc.cura Sc r,� t ,! u y �r ..:4dv� r.nn xwa� 0 :<<, n,rir valve exceeding $2500, the applicant nni
inspection will not be approved aril a t : Hspeclion fee will be charged. I
..Signature
Contractor
The foregoing instrument was acknowledged before me
this-
, 20 ,' by — , day of 20 t r , by "?'i&ittct, mLvet.
ho is personally known to me or who has produced
As identification and who did take an oath.
NOT A RY " PUBLIC:
Owner or Agent
The foregoing instrument was acknowledged before me this
Sign:
Print:
My Commission Expires:
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APPLICATION APPROVED BY:
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APPLICATION APPROVED BY:
(Revised-02/08/06)
gnaturc
as identification
IC:
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NOTARY
Sism
Print:
My Comm
who is ersonall known to moor who has produced
LOIVMZO
COMMISSION # OD 502054
Thal NgarYt MictindearsNp@:
Plans Rxa mr�a -
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Plans Examiner
Engineer
Zoning