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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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. A - Signature CO Owner or Agent Contractor The f regoing instrument was acknowledged b �r •� The foregoing instrument was acknowledged before me this day of 1 20 /L) by �. zg kttrw day of C by 1,1AY95' iii 06 p who has produced tI1l� as identification and who did take an o who is personally known to me or who has produced As identification and who did take an oath. NOTA Y PUBLIC: VANESSA V. PEREZ Sign: 1 Print �t'� I\i^�` -�+� ee Is-'A: 4 Ex !-es 387/2011 •,9,n c' r�ltnLa ra. --y Assn.. Inc My Commission Expires: Z z _ raeoe - - -.. ....."moos® NOTARYPUBL . n • Sign: Print: ' C. ` L _ J My Commission Expires: 1 I C� q2 io.t$ie3e9e.ic****ir****ir*** tie **** Y *x*.Sr9cia****.k.s.Y4e****** ** ir$*4e*{sir &nhi *** writ. h9e4r9zit**aYievk*k *sr**********& ar**dr4catiicde xiaia$c9eit4r*** (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