PL-06-1605cCo pp
Z S I'M
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type (circle): Building Electrical
Owner's Name (Fee Simple Titleholder) 3- (4 `C\A1.
Owner's Address a) a3 ?r lmrp ' C
City [Ai 1S.1 A State FL,
Tenant/Lessee Name `R I
Job Address (where the work, is being done)
Architect/Engineer's Name (if applicable) Vsk ! Pc
Bond $ 00 Code Enforcement $ Double Fee $
C.3 Structural Review. $
r r ' • r
Miami Shores Village
Building D epartment
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit NoTt l,�l� — LO5
Zip
Master Permit No.
Mechanical Roofing
D ii'r Phone #
333
Phone #
Phone #
Total Fee Now Due $
RECEIVED
JUN 1 3 2006
City Miami Shores Village County . M Dade Zip
FOLIO / P A R C E L # \ k - 3 ) . 0 6 — 6 ® 4 ° - C ® ).
V
Is Building Historically Designated YES NO p� ,,
Contractor's C o m p a n y N a m e D Kt En U t r o 'M. e.Ye \ \ S A - o ne # 9 . 5 4 X.1, L A . - 9 0 ' ) - Q
Contractor's Address 1 14 ). ` ' Yi e2tA CAIN t Vc '),,
City �1 k \`o Cis State 0-- ` 3 3 1.7 - 5
Qualifier Name C� .,Q.\i _ 'C Laek h.k Pho 5 ' Z VI L(- 6 7
State Certificate or Registration No. 5 r( 6 °I `3 1, `'). 3 Certificate of Compe ) o. 57 3 3 4 l ..,c,
o6A.P• LR
CSR<D9131VA
\\ `r
Value of Work For this Permit $ 115 00. 0 0 Square / Linear Footage Of Work: 3 0 cS ( �T
Type of Work: ❑Addition ❑Alteration ['New 13 ❑ Demolition
Describe Work: I151 4q1 \GA x0 ac O't1 S Ore_ .. --t e, Ave f SZ .1s A-eY■A.
C ON-04A 1\ 9 ∎'Q1,6)
********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * es * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ , 1 6' CCF $ 20 CO /CC
Notary $ 5 , Training/Education Fee $ 0 Technology Fee $ 4
Scanning $ ' - ®O Radon $ DPBR $
Zoning $
See Reverse side
. 0 .
Bonding Company's Name (if applicable) 111r
Bonding Company's Address ;
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City - State
APPLICATION APPROVED BY:
(Revised 02/08/06)
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.
"W ARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE TOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,
CONSULT YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT."
o to Applicant: As a condition to the issuance of a building permit with an estimated value_exceeding $2500, the applicant must
pr Ise in g' ood ftaith that a copy of the notice of cowmen • ewe t Ode, of tr_u4t[n liee' l r Ti e will be delivered to the person
whose property is subject to attachment. Also a certified copy bf the � r'ecar ied f ` , ent 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 proved and a reins.ection fee will be charged.
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 13
day of , 20 , by day of ia , 20 (6, by bid VoitalTa Bipoir
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. � as identification and who did take an oath.
NOTARY PUBLIC: -- y`7TARY PUBLIC:
y
ovoi U,A\ M4., ' i r k = 11 1 ei
Sign: \ D �a V�9.,. n r
Print: it: Am h P
My Commission Expires:
1V .
X7-e, ✓ t S
Commission Expires:
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Plans Examiner
Engineer
Zoning