EL-05-1155BUILDING
Miami Shores Village
Building Department
(0050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: ( 305) 756.8972
Permit No.
l'
MAR 1 g 2010
BY:
EL -/2- 05 -1/55
PERMIT APPLICATION Master Permit No.
FBC 2001
Permit Type (circle): Building + l
Owner's Name (Fee Simple Titleholder) 11.05 0 Her rim 2 Phone # / ��a ZZ % /�
• (0.2.00
Owner's Address 1y 118 . NE q �t
cit FL
Tenant/Lessee Name
Job Address (where the work is being done) NE q `0 V
City Miami Shores Village
Is Building Historically Designated YES NO
Contractor's Compan Name Q r O(d i t -� J S CL fl e # 3oa • +Up • 3 -1
Contractor's Address 649 t N W 1 1 Sfi 101 o�
City DV J State rt— Zip 3310
Qualifier 09166
Plumbing Mechanical Roofing
Zip 1
Phone #
County Miami -Dade Zip 33I 3 ® °
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit Square Footage Of Work:
Type of Work: grAddition ['Alteration ❑New ❑ Repair/Replace ❑ Demolition
Describe Work:
bury A- 1 ,121\n -enrwa
****************************F
*** * ** * * *** * ** * * *** * ** * ***
Submittal Fee $ Permit Fee $ / ' ' ® CCF $
9 '
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $ 1 l
(Continued on opposite 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 ' .plicant must
promise in good faith that a copy of the notice of mmencement and construction lien law brochure will be delive ' to the person
whose property is subject to attachment. A.:; a,certified copy of the recorded notice of commencement must be po: 'ed at the job site
for the first inspection wh:% occur < en )' days after the building permit is issued In the absence of su.' posted notice, the
inspection will not be • r� owed r a rei r >ection ee will be charged
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this
�
1� 1
day of M , 20 l0by 1.Ut5 \ Y ( QrdQ Z
who is.personally known to me or who has produced b - j9( It c.
}4(955 `53 L) i -Z-iiteritifiQion and who did take an oath.
FJ azmin Lopera
My Commission DD877398
NOT ; ' Y PUBLIC:
Sign:
My Comm
* * * * * * * **
***** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc 10/14/03
Signature
Contractor
The foregoing instrument was acknowledged before me this 9
day of 1 car-th , 20 10 , by T)CtS3et
who is personally known to me or who has pr1uced
as identification and who did take an oath.
NOTARY P
Sign:
Print
APS ? Notary Public State of Florida
Jazmin Lopera
o 4e,'"� ' 4 tir ' * * * * * *a**
oi
My Commiss
* * * * * * * * * * * * * * * * * * * * * * * * * * * **
ertificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
***************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning