EL-11-149Miami Shores Village
Building Department
>0050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2001
5307n 311
JAN 282011 VI
BY:
Permit No. tJ 11 —(49
Master Permit No.
Permit Type (circle): Building E lectrica Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) L. ®V'ocw"e G-0,1 j1RQ,Z Phone #
Owner's Address l 2' P' N � bt-i ' 5-I-.
ig
City ��� State NE G Zip 3 -515 0
Tenant/Lessee Name
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO
Phone #
Contractor's Company Name Any, PX' ,t ,ceu, (`k SCI l klij 'fhone #
Contractor's Address 9 L �. N . -"))01) t) \Ai
City State u t
Qualifier Ultil &. AfQ(c
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit
Zip
Zip
Square Footage Of Work:
Type of Work: ❑Addition ❑Alteration New ❑ Repair/Replace ❑ Demolition
Describe Work: I1A \-- (A \Cc \k\or (p - I 0 Alp \k ccc NT(vax CHIC x n ck ct,e, Y1
****************************Fees******************************
Submittal Fee $ Permit Fee $ A' ��'r ®� CCF $
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $ 5) , k 0
(Continued on opposite 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 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) 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.
A -
Signature
CO
Owner or Agent Contractor
The f regoing instrument was acknowledged b �r •� The foregoing instrument was acknowledged before me this
day of 1 20 /L) by �. zg kttrw day of C by 1,1AY95' iii 06 p
who has produced tI1l�
as identification and who did take an o
who is personally known to me or who has produced
As identification and who did take an oath.
NOTA Y PUBLIC: VANESSA V. PEREZ
Sign: 1
Print �t'� I\i^�` -�+� ee Is-'A: 4 Ex !-es 387/2011
•,9,n c' r�ltnLa ra. --y Assn.. Inc
My Commission Expires: Z z _ raeoe - - -.. ....."moos®
NOTARYPUBL . n •
Sign:
Print: ' C. ` L _ J
My Commission Expires: 1 I C� q2
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(Certificate of Competency Holder)
State Certificate or Registration No EbaN 10 Certificate of Competency No.
** *fie ** MAN * * ** *** * ****** ** ** ** ** * * ** ,.... }****4********************** * ***** ** ** * * *** * ** * ** ** ** ****** 01.1* *1 O flti
APPLICATION APPROVED BY: ®► _��' 5 , 9 // Plans Ex.1 n1 H
N
Engineer W Z u v
Zoning
chc 10/14/03