BP-05-506BUILDING
PEII'.,I €AT
FBC 2001
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
_1eh 00)=7,95,2204 EaxL(305) 756.8972
U4�t e,
Permit Type (circle): Building Electrical Plumbing Mechanical oofmg
Owner's Name (Fee Simple Titleholder) Lucius Fox Phone # (305) 759 -3852
Owner's Address 575 N.E. 105 Street
City Miami Shores State Florida Zip 33138
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 575 N. E. 105 S t re e t
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES
City Miami State F lom
Qualifier Carlos Arocho
State Certificate or Registration No. T26 0 0 5 8 6 2 7
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village E to if)
Building
Department
NO x
Code Enforcement $ Structural Plan Review. $
Permit No. OS
Master 1W No.
Zip 33138
Contractor's Company Name Quality Roofin /C ntractor Phone # ( 305) 751 -0382
Contractor's Address 13800 N. W. 1st Avenue-
Zip 33168
Certifieate6f Competency No. 000017889
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit $2,000.0 0 Square Footage Of Work: Repairs
Type of Work: DAddition ❑Alteration ❑New j Repair/Replace ❑ Demolition
Describe Work: Repair leak on front overhang of tile roof.
Repair leak at rear flat roof overhang.
6200 SI *** * * * * * * * * * * * *** * * * * * ** * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Co Permit Fee $ CCF $ a CO /CC
Notary $ Training/Education Fee $ 0:4 T(,> Technology Fee $ , 5
Scanning $ Radon $ Zoning Bond $
Bonding Company's Name (if applicab
Bonding Company's Address
City State Zip
Mortgage Lender's Name'(' plicable)
Mortgage Lender's Address
City State
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) deys the building permit is issued. In the absence of such posted notice, the
inspection will not be app '. ed and a reinspection eewil;1 harged
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this
day of , 20 05 by Lta c, et•.. 5 FOP
who is personally known to me or who has produced
As identific - 'on and who did take an oath.
Chc 05/13/03
NOTARY PUBLI
Sign: -
Print:
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
A
•aa ' t MY COMMISSION # DD 060579
EXPIRES: October 10, 2005
The forega �t was acknowledged before me this /
day of , 20 by &A, , A ,
who is personally known to me or who has produced
as identification and w did take an oath.
1 , • ' • 1
NOTARY PUBLIC:
Sign:
Print:
Zip
Contractor
Po
My Commission Exp u' ' <� MY COMMISSION
ob # r D D, 60 9
* * * * * * * * * * * * * * * * * * * * * * * **
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*APR 12 2C5
Plans Examiner
Engineer
Zoning