DS-10-1304BUILDING
PERMIT APPLICATION
FBC 20
Pe .X
_..- NG ROOFING
Permit "type: $'I3'IL�
Owner's Name ('Fee Simple Titleholder) V 61c.4)4 06 4,P c4.0 . Phone '# ( 3 G5) 7 5 / d 3 :t
Owncr's: Address
.
City 04 /4/0-4P 6/ : itt, 5 State' F 1 i ! de4 Zip : 3 3
Tenant/Lessee Name . Phone
Email
Address (where ) r7: . N. (Ai /0 9. .' Jo (where the work is being ' done•
City M'ami Sho - '.. Villa se
FOLIO / PARCEL #
Is: Building historically Designated YES N
Miami Shores Village
Building Department
10050 N.E2nd Avenue, Miami Shores, Florida 33138
TO (305) 795 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305' 762.4949
County Mianii -Dade. 'Zip >.
Permit NoI W 1 bO
Master Permit No.
Flood Zone
Contractor's Company Name; / C . 2 K ; r'� f�- � Phone:# • c' ') s c4 3. •
Co AMdress '! , : = ::.mac` : .t;; i /..:0: e . $ 6 ..
M r ft-t S State /= (0 i2 ��# ' zip 3 5 1 b 1
Qualifier Name Phone #
State Certificate or Registration NO Certificate of Competency No.
Contact Phone E -mail
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ 9 , S 0 Square 1 Linear Footage Of Work; - /
Type of Work °Addition. DAlterati'ipn f New 3 i Repair/Re p � la �c` ❑ Demolition ..
Describe Work 2/ -_� :' -- f� � g-- W f Vr/ Y Q !
* ******** ** * ** ** ** ** *** * *** * * ** * * ****** F * * ** * *** ****** ***** ** * * ********** ** *** * * **
Submittal Fee T60 • Permit Fee $' /1/0O CCF S Q ( Q
Notary $ TraininglEducation Fee $ 0 '040
Seaming .$:(.0' Radon $ DPBR $
Double Fee $ Violation date.: '°
Structural Review. $ Total Fee Islow Due $ '. 1
CO /Ce $
Technology Fee $ :
Bond $
See .Reverse side -i•
1.
Signature
The fo ' o' • g instrument was ac edged before
day o , 20, by
who is , ersonal known to me or Who has produc
NOT PUBI.i.CC:
l
Sign
Print:
My Comm ssion Expires:
. Owner or Agent
9r3c *Ye*****9f.*** ***ie ***
APPROVED BY .'= Plans Examiner
(Revised 07 /10 /O7XRevised 06110/2009)
66TIA4Loty
7zto
s
kt L!J
116.:
As identification and who did take an oath.
J
.>"
'
'0 4u.N `'ti
* ******old*** k** ***
•
• OC
•
Engineer
Zip
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of 20 , b y
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:
********* ir**********************9 ***************** t** **ir., **
/ Zoning
Clerk checked
it
Bonding Company's Name (if applicable)
Bonding Company's A.ddress
City State Zip
Mortgage Lender's Name (if applicable)
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 fob site
for the f irst 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 be. charged ;:
Note:
c
2
w
0
U
L
m 1
u�nti
P
of
W
w
0
a
v
w w
_D H
ui u.,
•
•
••
i `
•.1 1 4 2
•
15' ALLEY
ate
t o
e.4 9
Q®
BOUNDARY SURVEY
c c o
pl omtax y • �
IBS•
0
to: •••
••
rc L
\,
!o arspl+. pavtn'+
K
II. covic. sLa4�'
2q. 5'
1 STY. ccs REE .
1.1e. 174
F, E. /.= 12.88
_ zt. 6'
k vV. • • f 0: 44 '
•
L14 ••w;f
•.
• •
• • • • •
•• • • •
• .•• •
s Mi ¢ mot 4o u.G.V.fl, ('n
' r
. 4 NJ to
1 o 3'•d b_-.
meridian
3.5 co.ic
{ walK
.. i�
O
T
1
9 00
N Fouvict
Pipe
•
'00MgWZR
' i
Fo d
LLt
SCALE: 1" = ZO'