CC-08-20901212GIby
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10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Td;-4-105--)- a : ) 756.8972
a rte e iV LL
BUILDING CEC Permit No. o »2tYjD
PERMIT APPLICATIO jo '9' , Master Permit No.
FBC 2004
Permit Type (circle):
•
Owner's Name
(Fee Simple Titleholder) %AVM. SQCQ• • 1 A3UG;"1"b.� Phone #
Owner's Address 'e_9 b 'c t ZokA off"
City State L Zip 3 1 4 (3
Tenant/Lessee Name Phone # < ��5 SAt5C3 B 6 2:
Job Address (where the work is being done) c A0 b.) AD E.
City Miami Shores Village
FOLIO / PARCEL # — (56 — Okt . - 10X10
Is Building Historically Designated
State Certificate or Registration No. Ct C /2 4 2.7
Value of Work For this Permit $ 2( 500
Miami Shores Village
Building Department
Roofing
County Miami -Dade Zip
CALi
3'3- 235 0 3(v2- ejs.L
305- 45013e6
Contractor's Company Name G ' R- �, e40/1, S CND Phone #
Contractor's Address 1
City MLI'it, 1 State I � Zip
Qualifier Name v® 4 • GM c/ k Phone # 3o,r S 03
ompetency No.
Architect/Engineer's Name (if applicable) Phone #
Square / Linear Footage Of Work: 24°t 0
Type of Work: DAddition 11Alteration [New D Repair/Replace [ Demolition
Describe Work: Ac, 0:1G &�c�� Lha 1 4s,5,
et 4 t * * * * * * *** ********* ***** a: ********* ***** F x************ *** ** * ***** ** *** * ************
S F ee $ Permit Fee $ CCF $ CO /CC
Notary .$ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ k; '1' Total Fee Now Due $
See Reverse side -)
— "7.07 1 SE 1058 ilEni 1:154804 Olga
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 •? l `" 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 .regdlating construction and zoning.
e
"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 comjne�nctemen and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certifie2t- elpp.., /off M recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the. i iir - permit is issued In the absence of such posted notice, the
• e approved and a reins ection fee will be char ( O
PP P f g ,
inspection will
OA , mg
/
Signature- i
afore Y. "
�, ..._.. er or Agent v C . ntractor
The foregoing instrumen as acknowledged before me this I The foregoing instrument was ackno ledged befor e me this
day orb c , 20 ®� by - o nel � K ®I�
y y C �, r� Z� day of , 20 ® , by , 4,
who is personally known to me or who has produced who is personally known to me or who has produced
As ide
NO
Print "AAA � ��71 `
My Commission Expires:
APPLICATION APPROVED BY:
(Revised 07/10/07)
who did take an oath.
.t P
DELIN ALFONSO
?° ~� `A. Notary Public - State of Florida
•
*�xa�**** x�x****** ��x�z�x.x�x�x +a � ; a y Co min a ° n # D1�6 7 0
n� °` oa; commission # DD 534911
° "i„dit"s r Bonded By National Notary Assn.
as identification and who did take an oath.
0
.Nii� iii. [yy�iD��Ey,yiL,IN ALFONSO ,.yy
- My Commission Expires Jul 22, 2010
Commission # DD 534911
X q' ciao' Bonded By National Notary n.
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TARY PUB LIC•
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