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RF-06-1895Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fag: RE 96.8972 BUILDING JUL 14 �QQ� Permit No. RFO6 IBS . PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type (circle): Building Electrical P mbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) _ n ,S-e 4_ erne Z Phone # 3 0 5) 754 — 3 © Y 3 Owner's Address ;31 h wee City C - vo S A State FL— Zip 3/3E' Tenant/Lessee Name Phone # Job Address (where the work is being done) 31,5.- NE City Miami Shores Village C oin' i -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES Value of Work For this Permit $ 1, CC° Type of Work: ['Addition ['Alteration Describe Work: p ¶ 6.r - 1 e,P- -, Xs" L NO Contractor's Company Name C.9 ' # / p Y h Phone # Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Square / Linear Footage Of Work: n Repair/Replace hlt ❑ Demolition k *** *, ** **** ** * ******* * * ** * ** *** ** ***F ** *ii** r ** *** ** * * * * * **** * ** *,ter * * *** * ** **** ** Submittal Fee $ Permit Fee $ /1,6 ' CCF $ CO /CC Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ 1l ,, (' Structural Review. $ Total Fee Now Due $ 'W ` �� � See Reverse side _6JL P4 IJ Bonding Company's Name (if applicable) Bonding Company's Address City 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 building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of com en eme1 t and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a cert ed-cp$y:ldtthg recorded notice of commencement must be posted at the job site for _ the first inspection which occurs seven (7) days after theItildirl permit is issued In the absence of such posted notice, the inspection will not be approve# - a reinspection}ee ill be char d. Owner s r Agen The foregoing instrument was acknowledged before me this t4 20CfQ by day of who is personally mown to me or who has produced identification and who did take an oath. NOTARY P Sign: Print My Co sion Expires: (Revised 02/08/06) State Zip na= - bxpites:Ju, 73,2C:7 Bonded T hru Bonding Co ( 1111 - 11M- 1 fi i -_, Signature 4 The foregoing instrument was acknowledged before me this day of , 20 _, by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: ************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: 11 D l0 Plans Examiner r Engineer Zoning