RC-06-26703‘m Miami Shores Village FolEEV5E1
o A I Buildin Department OCT 26 2006 DJ
, lr�C g
5 ,A�,.� ji- . � 4 p'O]. Q950 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 7952204 Fax: (305) 756.8972 BY' """
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type (circle): Building Electrical
Owner's Name (Fee Simple Titleholder) Z W, i3 ,H, L . hone # �®.5" 3/00 79 7/
?rod
Owner's Address
City/1l40f / 577 State ��
Tenant/Lessee Name
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL # l/ ",3.2 CC' — ®Qs- OO
Is Building Historically Designated YES NO !ate
t
---
Contractor's Company Name oPOS i Phone # 3 r ' S/� �T 7/
Contractor's Address /3 3 are/ 4 A- 0-C,
cit bilt.)/ -e_. State (, Zip 3 3 g 2 S �
Qualifier Name
State Certificate or Registration No.
Architect/Engineer's Name (if applicable)Cp o,p , v "'Sig G/ � hone # 305 - - 4
Square / Linear Footage Of Work: 1 /t5 - De)
Value of Work For this Permit $ 00000, () 0
Type of Work: iJ, << '. n ['Alteration
Describe Work: s , d , e
Arbil-tar) .
1;iLL
Radon $
/u/A
87 '0 6 (71 /-4 377- e
Zip a5/ 3e->
Plumbing Mechanical Roofing
Permit No.gC& " 2E
Master Permit No.
Zip 33 / 3e
Phone # /VA
Phone #
Competency No.
Repair/Replace ❑ Demolition
J2 L'U fC ..
* *** ** ** *** * * * ** Fees* * **- * *, ****** * ** ** * * *** * * * ** * * ** ***** * * * ***
Submittal Fee $ 25D CC) Permit Fee $
Notary. $ ` Training/Education Fee $
Scanning $
Bond $ Code Enforcement $ Double Fee $
CCF $ CO /CC
Technology Fee $
DPBR $ Zoning $
Structural Review. $ (® = " 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 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
promise in good faith that a copy of the notice of commencement and construction lie
whose property is subject to attachment. Also, a certified copy of the recorded notice
for the first inspection which occur s seven (7) days after the building permit is'
inspection will not approved and : • will be charged
As identificatio
NOTARY PUBLIC:
Sign:
14/
Prin( Ycaritioe U too—
My Commission Expires: fKI09
APPLICATION APPROVED BY
(Revised 02108/06)
(1 41116.
Sign:
!ue exceeding $2500, the applicant must
Ochure will be delivered to the person
mencement must be posted at the job site
In the absence of such posted notice, the
Owner or Agent ,--,,_ Contracto
e foregoing instrument was acknowledged before me thi ;; The foregoing instrument was acknowledged before me this
day of ZS , 20 Q, by �abucs, ( 4) cz.L4 , day of , 20 64, by e r
o is personally known to r who has produced o is personally known to r who has produced
didfq ate of Florida as identification and who did take an oath...
Jasmine Flake Westbrook
My Commission DD472584 NOTARY PUBLI
Expires 09/1512009
Print: 6/N ;44_ E1 u{ ti✓a+T41rt30k.
•
My Commission Expires: y�n/
Plans Examiner
Engineer
Zoning