DEMO-11-1164Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit No. DM
Master Permit No. 11® (05
BUILDING
PERMIT APPLICATION
.saligainas PAIL 07007
Permit Type (circle): Building Roofing
Owner's Name (Fee Simple Titleholder)
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Owner's Address go ��s, '---
CityVktift", S t' State
JUN 272011Li
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Tenant/Lessee Name
Phone #
Zip ;3/3g
Phone #
Job Address (where the work is being done)
City Miami Shores Village County
FOLIO / PARCEL # 012.1D
Miami -Dade
Zip 73/
Is Building Historically Designated YES NO_4_
Contractor's Company Name Q 2.Q j C t
Contractor's Address it-twIt N w c cA
City KtkAPVI State
Qualifier Name /�
State Certificate or Registration No.0 .(..12- 1 9f
Phone #,( .0 4,57- t) Z
Zip 7T1Z FK
Phone #
Certificate of Competency No.CA 601 CL'
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $ goo, .'
Type of Work: ❑Addition
Describe Work:
Phone #
Square / Linear Footage Of Work:
❑Alteration ['New
MC_ taG.4
❑ Repair/Replace
G
emolition
************************************Fees**********************
* * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ // v""1 CCF $ CO /CC
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $
Total Fee Now Due $
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 CONDITIONERS, ETC
OWNER'S AFF!DAVIT: 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.
"NVARNING 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
or Agent
The foregoing instrument was acknowledged before me this
day of ,20_,by
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign: �/'• a ?��.
Print:
My Commission Expire
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of ,20_,by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
To0C-SISgs(tole%
012
s' w 9
My Commission Es.
* * * * * * * * * * * * * * * * ***** :•x******** ** ****** ** * * ** ********* ****** *****a: a:********** **** * **********************
APPLICATION APPROVED BY-
(Revised 07/10/07)
Plans Examiner
Engineer
Zoning