CC-09-1984Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit 1113 CJT
Master Permit No.
BUILDING
PERMIT APPLICATION
FBC 20
777137
DLL, 0 - 2009
BY:
Permit Type: BUILDING ROOFING.
Owner's Name (Fee Simple Titleholder) 1? j/VQ p.0 v"1i Phone #
Owner's Address 5-4' 0 it ( V L1.6- Lie 4- AV 1N1 I-40 L® 11(6
City/A(4. Sifbies 711 it stye FL- zip. 3 3137
Tenant/Lessee Name Pig-LK-5 fiC1 e 0,00E, Phone # 7 bs -9-33 3 357
Email G FO (J /1/1-14-KC 1- tdtC.-.pkuCssCoAl
Job Address (where the work is being done) 9-53? t- 1-5-1-1( 1j z_ 4-v &ivy E;-
U
City Miami Shores Village County Miami -Dade Zip ?3/
FOLIO / PARCEL # / r r 3 2Co (p - ® (3 • 39/ 0
Is Building Historically Designated YES NO
Contractor's Company Name
Flood Zone
Contractor's Address / 5 AJ
9 9 (
City /" gq /n I A-Mf Ch, State F-L Zip 3 )(Co Z-
Qualifier Name S1- J E-K.) K ®,P1 ,3 Phone # 3 ®y 00
State Certificate or Registration No. C 6 C 0"3 f r ( I Certificate of Competency No.
Contact Phone )0S1- 7 ) 0 3 E -mail 1 NF CQA1
Architect/Engineer's Name (if applicable) i1 A *iL e414 l I't r -L L Phone # r s L 2.'" 7 0-32
Value of Work For this Permit $ ®x) Square / Linear Footage Of Work: 3 02/ S F
Type of Work: DAddition ,,iteration ['New ❑ Repair/Replace ❑ Demolition
Describe Work: 7 qi/ Ce ) 61Ay
CAtit-PM 4 Ke40064 cif LPL; �1R/ MOC.dPei) l L
fit ,17 it) C. Cu ,a fal'"i „ Flu 6
(J) /VOA) f iiaaL 1( Pei D
®EC 0 3 r ,3
********* * * * * * * * * ** * ** ** ** * * * * * * *** * * * *F * * * * ** * * * * * ** * * * * * ** ** *qtr *, * *,r *** * ** ** * * * * * **
Submittal Fee $ Permit Fee $ CCF $
Notary $
Scanning $ Radon $ DPBR $
Double Fee $ Violation date:
Training/Edncation Fee $
CO /CC ,$
Technology Fee $
Bond $
Structural Review. $ C9000 6 4' G0, eg Total Fee Now Due $
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 YO URA '" ;ENDER OR AN ATTORNEY BEFORE
�,�.
RECORDING YOUR NOTICE OF COM e , NT."
Notice to Applicant. As a condition to the issuance of a building permit itlt lan^t mated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and constnw p *Jaw brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded noe'' - f ommencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is is wed. , the absenc of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. 1,'
Owner ent
The foregoin . trum��^^ennt�tt� was acknowledged before m� ee this
day o(JCJ2 ` , by 12.�o n VT dC.,.C'1 —Z
who is personally known to me or who has produced -ft/a,
As identi ttion and who did take an oath.
NOTARY PUBLIC: 04'1>
=
Sign:
Print:
My Commission Expires: 4,4; ,' Is toll -
Signature
Contract
The foregoing instrument was acknowledged before me this /10
day of ®G► — , 20 a9 by STE-ved K.®pA, ,
who is personallv known to me or -who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign.
Print:
My Commissio
F
o` Notary ' u
—•� n
`=NIy Commission Expires May 21, 2010
Tit Commission # DD 555135
O �I��� Bonded By National Notary Assn.
** ** err************* ** * * * ***** *** *x * * * * *** * *** *** *, ** * ** *** * * *:r, *,a*x* * ** * * * * *x * * * *** *** ** *** * * * * ** * * *x * * **
APPROVED BY
Plans Examiner
Engineer
(Revised 07 /10 /07)(Revised 06/10/2009)
/2/y 07,
Zoning
Clerk checked