EL-06-969MaSsAGI
10: GZ AM 4I14I0(a.
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305)795.2204 Fax: (305) 756.8972
BUILDING Permit No. ELM 9
PERMIT APPLICATION A, 211 Master Permit No.
FBC 2004
BY:
Permit Type (circle): Building Electri a �Pluumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) JO 4 p7 CN �t"'�G/er Phone # 3 0s -7S 9 g *7 / p
7
State t,
Owner's Addres
City
Tenant/Lessee Name Phone #
Zip 3 313 i°
Job Address (where the work is being done)
City Miami Miami Shores Village
FOLIO / PARCEL #
County . Miami -Dade
Zip
Is Building Historically Designated YES
NO
Contractor's Company Name 44tti G C. Phone # P03)737-6930 634
,
Contractor's Address /05-5-/ /ye e l
City ` i let( • -� State r Zip
,' qit Phone # (5e) 7 3617-62390 o )
Qualifier Name G
State Certificate or Registration No. EC tat /rg. Certificate of Competency No. 5f 4r
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
Type of Work: ❑Addition
Describe Work : CifVt
Phone #
❑Alteration
Square / Linear Footage Of Work:
:New
/° ❑ Repair/Replace p9P to,
Ge
******* * * ** * * * * * * * * * *** * ****** * * * * **** Fees************* * * * ** * ** * * * * *** * * * * * ** * * * ** * * **
Submittal Fee $ Permit Fee $ P Co, e> CCF $ I - 2- p CO /CC
Notary $ S - 00 Training/Education Fee $ 0 • 4-0 Technology Fee $ 3 - -I S"
Scanning $ 3. 00 Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Total Fee Now Due $ ' b 3 .3G
Structural Review. $
See Reverse 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 CONDTTIONERS, 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) 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.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this ,%3
day of JAW , 20 Off', by 500A) ofiJ / /
who is personally known to me or who has produced
O3 ` L 'As identification and who did take an oath.
NOTARY PUBLIC:
,a
Contractor
The foregoing instrument was acknowledged before me this 1 �j
day o A't"' 2-1(_, 200,31 CAJT
J)cn
who is personally known to me or who has produced
�u
1 4.1 401141110,r4
. • 0,2007
4 ` � � • :' DD221662 —*A/C /f%
as identification and who did take an oath.
NOTAR I $ it a iP" sy papu�
za �LQ uotSS1„
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Sign:
Print:
M Co
ission Ex
* 141 ° laandeetlyQ1edloaatN kJ ikes% ************************ * * * *** *** ** *** ** ** * * **** * *** * *, ter, * ** * **** *** ******
APPLICATION APPROVED BY:
(Revised 02/08/06)
Engineer
Zoning