DEMO-09-442e5\7Lbck.
Miami Sh
Village;
Buildta artrnent
10050 N, :,2nci Avenue, ' i an!i Shores., Florida 33l 3
Tel: (305) 795.220 la ::,x: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type (circle) :( Buildin
Roofing
Per
mit Na. ptu O -7_
Master Permit No.
Owner's Name (Fee Simple Titleholder) b mikAv3C_ �� (�tZPhone # •9 —51 S'
Owner's Address
City State Zip
Tenant/Lessee Name Phone #
Email
r-r
Job Address (where the work is being done) t291 1 A L t 0 2_
City Miami Shores Village County Miami -Dade Zip 7 7 [ j e
FOLIO / PARCEL #
Is Building Historically Designated YES
NO
Flood Zone
1 Contractor's .Company Name CO M — ife( -13i Phone # CIS-Li . -T .rt'i ^ (_[ ''"'
Conte tor's Address -).-,
ff``
-2
City I � 4 `-D ( (C State ' Zip 3 O
t— 1 LA iC - -5'C�� ukj Phone # ar C14 - (4 .. q q r
State Certificate or Registration No. C 6-7 C... 0 6 056 gertificate of Competency No. ,(
E -mail F(4 COW l /
3 P 4-6L` (z {� ,(
Qualifier Name
Contact Phone 5(T--g-z_ S— l L( 7
Architect/Engineer's Name t;if applicable) Phone #
Value of Work For this Permit $
Type of Work: ]Addition
Describe Work: g.
Square / Linear Footage Of Work:
(Alteration r1Ne;ri
.Lv (LAJ --r i>Acti (A. LAJD C 4
c_c_ j3 pq K
Repair/Replace Demolition
1 Z11,"l• * * * * * * * * *� * * * * * * * * * * * * * * * * * * * * * * * * ** **°Fees****************************** ** * * ** *x * **
Submittal Fee $ `JO + Permit Fee $ ,0 0 4" - CCF $ I • Uu
Notary $ _ Training/Education Fee $ 0 & 0 Technology Fee $ Z 5 b
DPBR $ Zoning $
Scanning $ 6.40 Radon $.
Bond $ Code Enforcement $ Double Fee $
Structural Review. $
Total Fee Now Due $ : (� 1. 1 b
Bonding Company's Nacre ( i applicable)
Bonding Company's Address
uty
ii/Iortgage 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 "ins'tallations is 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. lso, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs even (7) days after the building permit is issued. In the absence of such posted notice, the
inspection w.' no be ap r. r c xe' ection fee will be charged.
Signatu - _ Signature
Owner . ; :ent Contractor
he foregoing i nstrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of (1,-(07,42019,, by , day of 1 p' , Cti, 20 , by
who is personally known to me or who has produced who is personally known to me or who has produced /
as identification and who did take an oath.
NOTARY PUBLIC°
As identification and who did take an oath.
NOTARY PU
IL C'
Sign: { a-Aft Ct
Print:
/iy Commission Expires:
�o�Pav PO &% (AURA FARLEY
MY COMMISSION # DD 646761
EXPIRES: March 16, 2011
Bonded Thru Budget Notary Services
Sign:
Print:
"uk LAUfiA FARLEY
My Commission Expire# . ".. MY COMMISSION k DD 646761
EXPIRES: March 16, 2011
Bonded Thru Budget Notary Services
* * * * ** * * * * ** * ** x * ** ** ax * x * * * * * * * * ** x K x* * 1 *************************** * ** * ** **** ** * * * *** ** ** * * ** * * ***
APPLICATION APPROVED BY f P��
Plans Examiner Zoning
Engineer Clerk checked
(Revised 07/10/07)