BPP-11-2248027: •
,21
hizei
`'Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
il
PERMIT APPLICATION
FBC 20
ROOFING
OWNER: Name ( Fee Simple T tlehol e
Phone# 16- 7 11— qe(ig
Address: 1.0 ""! Pet k Att.
City: tM SW‘re
S State: Zip: 3313 e
Tenant/Lessee Name: Phone*:
1
Email: ' t ( t ri cjxotch Q ) 04„1 t . co,
A..140 , �I
WOW/ la
OB ADDRESS: � � 10 �/ � �
City; �s Shores '" Miami Dade
Folio/Parcel#: '`
C/L„
BY:... aa_o_o°oo ®®
Permit No.10 4I 22. u
Master Permit No.
f v
Is the Building Historically Designated: Yes
NO Flood Zone:
14 2
f
IAA
CONTRACTOR: Company Name: I �tvlri� Cof1D1QAA SF Phone#: '71 S T(XL■
Address: W i "1 kit
City: ql OVri j
Qualifier Name:
State Certification or Registration #:`;
„)\ti Contact Phone#:
a DESIGNER: Architect/Engineer:
Value of Work for this Permit: $ 01 WO • 00 Square/Linear Footage of Work:
Type of Work: °Addition °Alteration
Description of Work: (4201.-
New
°Repair/Replace
el 6
L/F
°Demolition
************ * * * * * * * * *** * * *+x*s. ****** * ***p * ***e era** * * *** **** *** * * ***xa.********** *****
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ _Structural Review $ 40 '
TOTAL FEE NOW DUE $
•
a
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 FI RCTRICAL WORK, PLUMBING, SIGNS,
WFLTS, 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 AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENC
Notice to Applicant: As a condition to the issuance of a
promise in good faith that a copy of the notice of co
whose properly is subject to attachment. Also, a ce
for the first inspection which occurs seven (7) tik
inspection will not be approved and a reinsp tthn
build'
The forego
day of
who is person
Owner or Agent
ONN LOPEZ
ih an estimated value exceeding $2500, the applicant must
construction lien law brochure will be delivered to the person
the recorded notice of commencement must be posted at the job site
she building permit is issued. In the absence of such posted notice, the
be charged.
Signature
The foregojsg in
day of La
who is personally
/4„
Contractor
t ''t n ONNE LOPEZ
??°� r;►G'' • bi Lary Public - State of Florida
Wlmedi4
an oath.
NOTARY PUBLIC:
Sign:
Print:
NOTARY PUBLI
My Commission Expires:
My Commission Expires:
***** ***+ kW+ H******** ***9. **+ P****** *Q+ *************** ******+RiM**+R*******d*** ABA+ koP************** *B**+A*ia*8 ****** ****
APPROVED BY
(Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09)
Plans Examiner
i-, Gtctural Review
Zoning
Clerk