The URL can be used to link to this page

WS-11-1859t1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 1 (1 _ t t INSPECTION'S PHONE NUMBER: (305) 762.4949 BU LDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING ROOFING �' OWNER: Name (Fee Simple Titleholder): �� fir Clai V Phone #: 3 04� 3 Gam' 3 3 04? � OCT 1 1 2011 Permit No. V\I v 11 )65C)1 Master Permit No. Address: r"dt 5 City: 9 t e S State: Tenant/Lessee Name: Email: Zip: Phone #: JOB ADDRESS: CZ, d „at City: Miami Shores Folio/Parcel #: County: Miami Dade Zip: Is the Building Historically Designated: Yes NO Flood Zone: '° CONTRACTOR: Company Name: NO'S" yd %E G' © ®k S Phone #: �^ �oJ �kJ�v� Address: 0 City: ®A 4- L., State: �< / P. L • Zip: 3%6. Qualifier Name: ✓e e s O v i T 7'/ Phone #: 3 ©J Anf ^"'©Jz 2. . State Certification or Registration #: Ce titcaYe f Competency #: Contact Phone #: Email Address: $/' & /Li0SdS 0©'S • cook/ DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 2. t9OC, Square/Linear Footage of Work: Type of Work: Addition DAlteration ONew jaRepair/Replace ❑Demolition Description of Work: �rQo� �j©©iz -- ci5l/�tilo'E' ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees**********>** * * * * * * ** * * *** * * * * * * * * * * *** * * *** Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 no ipprove4 and a reinspection fee'will be charged . • 4,110,/ �f /gent Signat The forego day ofd who is pers ment was acknowledged before me this by C//>01 tV4 NOTARY Sign: Print: My Commiss me or who has produced dentification and o 41c SPRY POs, LJ La CIRA M. OLMO (x. * MY COMMISSION I« DD 924445 EXPIRES: September 18, 2013 Bonded Yiuu Budget Notary Services Signature •,._ a \. . Contracto The foregoing instrument was acknowledged before me this a _ , day of , 20 _, by Cf Ag'.‹ ®� who is personally known to me or who has produced ��s a entification and who did take an PRY PUB RYrI U i1.• • ,I'o 14'0F FLO° n Expires: 9: '7e i/ APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /1O/2OO9)(Revised 3/15/09) 'Sign: Print: My Commission Expires: CIRA M. OLMO MY COMMISSION # DD 924445 EXPIRES: September 18, 2013 Bonded Yin Budget Notary Service // Zoning Clerk