WS-06-219210050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 - 05) 756.8972
1 1612:1
BUILDING � PERMIT APPLICATIO � �G � A 1 96
FBC 2004
Permit Type (circle):
Tenant/Lessee Name
Job Address (where the work is being done)
City Miami Shores Vill. e
FOLIO / PARCEL #
Is Building Historically Designated YES
Contractor's Company Name , M , °1 E 1,0
Contractor's Address C? 5
City (V IM. i (JLtim
Architect/Engineer's Name (if applicable)
Value of Work For/this Permit $
Type of Work: sl Addition
Describe Work: 4 6
Submittal Fee $
Notary $ J Training/Education Fee $ 1 43
Scanning $ 1 J°Uk1 Radon $
Miami Shores Village
Building Department
State
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['Alteration ,
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Electrical Plumbing Mechanical Roofing
uilding
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Owner's Name (Fee Simple Titleholder)
Owner's Address 1 .
City 1W Sh
10 C4YEA
Co
Anfi
ty
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Qualifier Name 3Th PUY 4Ja 0 OS Q
State Certificate or Registration No. C- & 0 (0 5491 Certificate of Competency No.
U c4N
Miami -Dade Zip 33 I T O
Square / Linear Footage Of Work: 0
Permit No. W O 21
Master Permit No.
Phone #
Zip 3138
Phone # —aTa.
Phone #
❑ Repair/Replace
tfuERs
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Technology Fee $
Vi wo-'4
•
Permit Fee $ OZ) CCF $ 4 ' CO /CC
DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $ Gi O
See Reverse side —+
❑ Demolition
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 b d ng permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencenrenf;and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy bfit re orded notice of commencement must be posted at the job site
for . the first inspection which occurs seven (7) days after the buil8` peit is issued In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged (
rm
Signa e '
'l
E Contractor
< :� � {
The fore oing instrument was acknowledged before me this / II The foregoing mst<a{ � was acknowledged before me this 4t,
' ?orne, � � (3VO of a ,20az),by of N Li[P I
who is personally known to me or who has produced a 'M
As identification and who did take an oath. O om b as identification and who did take an oath.
NOTARY PUBLIC:
day of 20 b�
NOTARY
Sign:
Print•.
My Co
who is personally known to me or who has produced
cnc
c�r�Flr�s�;tOt�
* * * * * * * * * * * * * * * * * * * * * * * **
sion Expires:
APPLICATION APPROVED BY:
(Revised 02!08106)
Sign:
Print:
•'. % % •
My Commission Expire �\ !:> 111 e.d` .
3, 2tk
Bonded Thru
Atlantic Bonding Co In
0
Plans Examiner
Engineer
Zoning