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RF-09-534BUILDING �ISlt�l PERMIT APPLICATION FBC- Tenant/Lessee Name Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 3313 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit Type (circle): Building /�� / Owner's Name (Fee Simple Titleholder) -�/ t `2�L! ua- Phone # £c=5 . ea ` Q / e 7 Owner's Address / 00 2-6 A,E . Cit /e /1�/n /c5A/l State Zip v 2 /3 9 Phone # 401/2 /!/ + �• Job Address (where the work is being done) /04: City Miami Shores Village County Miami -Dade Zip 3 3 C 3 9 FOLIO / PARCEL # Is Building Historically Designated � 1/ i& k Contractor's Company Name Contractor's Address 4/ City / 1i Qualifier Name State Certificate or Registrati Architect/Engineer's Name (if applicable) Value of Work For this Permit $ /1 Type of Work: ['Addition Describe Work: C /a/9V/ >1/e/ YES NO W((( h E c4/ o #i , /v Certificate of Competency No. epair /Z © .9/ — ,4 .5 2re ' /vF A( J A wm,ymvm,Immwmw Alteration ['New Ea/S ********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * *F Submittal Fee $ Notary $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side -> Permit Fee $ Training/Education Fee $ Permit No. 00q Master Permit No. ` 41) / vec . U i/vi Phone # 'V /Lid Phone # / S Square / Linear Footage Of Work: ' eplace E'ol ,tia ❑ Demolition s************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Naammmi la APR 0 1 2999 1.1ll 0 CCF $ CO /CC Technology Fee $ 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." 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 tc occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be #'pr' ed and a reinspection fed ill be charged. Owner or Agent '"° /j /7 Co actor The fore 'strument was acknowledg- before me this The foregoin trtii}4¢nj was acknowledged before me this day of .Et , 20 ®ei , by O G ,R 1.0 , r , day of ` ,by , who personally known tom r who as produced 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: (Revised 07/10/07) NOTARY PUBLIC -STATE OF FLORIDA " "'• Franciscn J. Pars Commission #DD787800 '• , ,,,,` Expires: JANE 29, 2012 BONDED THRU ATLANTIC BONDING CO, INC. as identification and who did take an oath. NOTARY PUBLIC: ime Sign: Print: My Commission Expires: *** ********* ******a:* **********+ x*** ******** **** ***a:************* ************** ****** x: **********+x******* ** **** APPLICATION APPROVED BY: Plans Examiner Engineer Zoning