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WS-09-12549,1)0 o BUILDIN C u PERMIT APPLICATION FBC 2004 Permit Type (circle): Owner's Name (Fee Simple Titleholder) L.44/4,9 ,e l A C f( Phone # 005 / 5 (Cr Owner's Address /25'0 D 6 .9 7 City ii > .5.4od� 5 State /1 Zip 3 3' 3P Tenant/Lessee Name Job Address (where the work is being done) /.2 55.7 ,)E 5 7 City Miami Shores Village County Miami -Dade FOLIO /PARCEL# //° 32 e5 — — ®5'S® Is Building Historically Designated YES Contractor's Company Name 7R& / C..) Contractor's Address - 239 g City Qualifier Name 1 4-69/2 <d 3cL) State Certificate or Registration No. �', 7 65 00 /& Architect/Engineer's Name (if applicable) Value of Work For this Permit $ /3 5'06 Type of Work: DAddition DAlte tion ['New Describe Work: G ' (f / // e/d _S JUL 7 PAID * * * *.*,r,r *.... r *...... * *rr *, .... r* ****Peen * ** ** * *** ******* *** * *,r,�,r ******* * * * * * *�r�r*** 0 Permit Fee $ 2 -OQ CCF $ K - 4O f, CO /CC Technology Fee $ Submittal Fee $ ej Miami Shores Village Building Department /0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Roofing Permit Nolan 195+ Master Permit No. Phone # Zip Eli JUL 2 72009 BY : 'o_m_ ®m.m 331 t/ State Training/Education Fee $ Bond $ Code Enforcement $ Double Fee $ Phone #(3©S) 9 ?Z 9 9 r Zip Phone # 33 , (309 °/ 72 y petency No. Square / Linear Footage Of Work: 3 6'6 57 f • r ® R' ❑ Demolition Notary $ " Scanning $ 9.. Radon $ DPBR $ Zoning $ Structural Review. $ Total Fee Now Due $ 6j 19' OP See Reverse side R• ending 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 CONDTITONERS, 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 Off' COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must ent and construction lien law brochure will be delivered to the person of the recorded notice of commencement must be posted at the job site ilding permit is issued In the absence of such posted notice, the d. promise in good faith that a copy of the notice of comm whose property is subject to attachment. Also, a certify for the first inspection which occurs seven (7) days after inspection will not be approved and a reinspection fee will be T 1 o identil 't4c i Wr1 VINO ' ° . S, Notary Public - e My Commission Exp'Ires Dec 19, 2009 Commission # DD50065 \19;1x!1 \ tazalp. 4P1: `+ tifica oC MA K I INEZ Notary ciickelida ' k I7, Commission Expires Dec 19, 2009 >� . 7 0 00�' Commission # DD500658 • NOT Sign: (Revised 07/10/07) Print: ....111■1 11Z_, APPLICATION APPROVED BY: an oath. eyo Owner or Agent The foregoing instrument was ac owledged before me this day of all , 20x, by day who is personally known to a .. „ >�:•� a who is e NOT Sign: Print: My Commission Expires: My Commission Expires: Contractor egoing instrument was acknowledged before me this r tir 20 , by oath. Plans Examiner Engineer Zoning