PT-06-483laml Shores Village
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Contractor's Address
City
Qualifier Name
BUILDING
PERMIT A$PLICATIO
FBC 2004
Permit Type (circle): Building
Owner's Name (Fee Simple Titleholder) 5
Owner's Address t 3 ( E ai +*- Si"
City itk. 6 x44, ) .e5State P L
Tenant/Lessee Name A)1 A
Contractor's Company Name 0 W !J. (
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $ Ibo •
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
ECEOVED
FE 2 7 2006
-Eke ____
Job Address (where the work is being done) lb( t g t `0 St
City Miami Shores Village County . Miami -Dade Zip r13 ( 3
FOLIO / PARCEL # 11 3204 • 0 1 5 — Z‘1
Is Building Historically Designated YES NO
Zip 5315%
Phone #
Phone #
State Certificate or Registration No. Cefc to of Competency No.
Master Permit No.
bing Mechanical Roofing
e2. Phone # YE• 754 - 5 5 5e
Zip
Phone #
Phone #
Permit No. • , ' (:)
.+eriat2. of tb Vse.
Square / Linear Footae4f Work:
Type of Work: ['Addition ['Alteration [New D Repair/Replace 0 Demolition
Describe Work:
* * * * ** * *** * * ** * * * * * * * * * * * * * * * * * * * * ** F * * * ** * * * * ** * ** ** * ** * ** * * * * * * * **
Submittal Fee $ Permit Fee $ ( t 7 G • 0 CCF $ 1 0 CO /CC
Notary $ 5 J .0(..3 Training/Education Fee $ r 20 . Technology Fee $ I e
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $ 6 - 7`D
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 value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement 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 approved and a reinspection fee will rged
(Revised 02/08/06)
er or A ent r� � 4 � �> Contractor
The foregoing instrument was acknowledged i - fore a this \ The foregoin t en as acknowledged before me this
g g g ,4,�.
20 , by lsl'� day of -'by
who is personally known to me or who has produced g h i tt rik , who is personally known to e or who has produced
ti 0510( ra As identification and who did take an oath. as identification and who did take an oath.
NOTARY LIC: NOTARY PUBLIC:
/°
Sign: , !f
Print:
Sign:
Print:
My Commission Expires:
My Commission Mires:
APPLICATION APPROVED BY: Plans Examiner
Engineer
Zoning