RF-06-1025BUILDING FeMEWYE Permit FaC I O-$
PERMIT APPLICATION it AP 1 LOR aster Permit No.
FBC 2004
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
c� 4 3 4 . 4 Tel: (305) 795.2204 Fax: (305) 756.8972
Permit Type (circle): Building
Owner's Name (Fee Simple Titleholder)
Owner's Address 1 a° g 1 l `
City M a--hO re6 State
Tenant/Lessee Name
Job Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL #
Is Building Historically Designated YES
Contractor's Company N e ii<ooivede-K
D, Box 53
Contractor's Address
City & WC%
Qualifier Name ��� tk,Vki
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $ 1 ic 24212
Type of Work: ❑Addition
Structural Review. $
(Al) 0 ie.I4- 5 rL'rF.rD
(dil ul A I -0 'i
Miami Shores Village
Building Department
y� ['Alteration [New
Describe Work: / `e- re I C-% r 11 04 e_
B Y:
Electrical Plumbing Mechanical
_-o
W,( ,per Phone # 3 c25' c25' 7,5q-0.0
Zip 33 13S
Phone #
la 'i 'iVE rT\
Submittal Fee $ O Permit Fee $ / 0 d 6 %1 1 ° C
Notary $ - CO Training/Education Fee $ 0 • 40
Scanning $ Radon $ DPBR $
Bond $ Code Enforcement $ Double Fee $
County Miami -Dade Zip
0
State Certificate or Registration No. Certificate o petency No.
ZaobGe Fes
� Phone # � , � -5:1� �q l C I 1
Phone #
Square / Linear Footage Of Work i
Repair/Replace
�- v - 1
Technology Fee $ 2 4130 •
Zoning $
Total Fee Now Due $
❑ Demolition
* * * * * * * * * * * * * * * **
$ - CO /CC
OM 9 lA
2IZ, .410
See R everse 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 At DAVIT: 1 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 condithiiPiim a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the n ote come r anent and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a cert ed CO y o the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after heild r it is issued In the absence of such posted notice, the
inspection will not be approved and a reins ection fee will be ch
Signature N.47 ey
Contractor
My Commis 1 ion Expires:
APPLICATION APPROVED BY:
(Revised 02/08/06)
Owner or Agent
The foregoing instrument was owledged before me this 2. 1 The fore wing instrument was ac dged before me this Z 1
day of IL, 20tby y 2lAYE A�l ayeO ' of el L, 20 b - r � ., :
who is personally known to me or who has produced who is personally known to me or who has produced
Lb
As identification and who did take an oath. as identification and who did take an oath.
NOTAR PUBLIC: Q 1 FLOR
I Imlay He IDA I;
�l ��ry
l' '� SUM D�47. - ,�' 0 » :LIC -ST G Is ,O
Sign: �.�y t Sign: 0 .1,.a� � 1
Pant: � '�,, ` _ Print: t l - 4 .. rl'� ! L `II ' � - ,
My Commis _is r �"��
* * * ** *** ***************'*************** * * * * * * * * * * * * * * * * * * * * * ** * * * * * * *** * * * * * * * * * * * * * *I * * * * * * * * * * * * * * **
NOT ' Y PUBLIC:
Plans Examiner
Engineer
Zoning