CC-11-2204Ji)ii_irro;
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
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: BUILDING ROOFING
Permit N
ISVMMT,
ia NO I
V282Q11
8Yam o- mae°oo
Master Permit No.
Owner's Name (Fee Simple Titleholder) Barry University Phone #
Owner's Address 11300 NE 2nd Ave
City Miami Shores
Tenant/Lessee Name
Email
State FL
Job Address (where the work is being done
City Miami Shores Village
FOLIO / PARCEL # 11- 2136- 000 -0050
Zip 33138
Phone #
Is Building Historically Designated YES NO
Contractor's Company Name /VQW CV Al 02/l/S C970'' .T /Ye Phone #
Contractor's Address /cf. i 4/ /t y W 42
City 6 / k
Aewil State
Flood Zone
3 os-- 6 /- yyYcp
//�� Zip 33007 r' rJ
Qualifier Name 0//t'N h' ; `1 t,*,v Phone # 3o.r 7 /-
State Certificate orrRegistration No. (e /SOW Certificate of Competency No.
Contact Phone 305=4 6(-(01,1(1 E- mail A/eosree■i%14- MAPCM14GefoAre 64°(fof/C , GOtij
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $ 45 / )40. 90 Square / Linear Footage Of Work:
Type of Work: ['Addition ['Alteration [New ❑ Repair/Replace ❑ Demolition
Describe Work: 1;f0/ 4,04/' / /4 'Fq 4,6 A i i4re , G✓-00//, "e.ofPZ,Z rd,
Submittal Fee $ Permit Fee $
SD e)
CCF $ CO /CC $
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Bond $
Double Fee $
Violation date:
Structural Review. $ U e cr.., 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 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 YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPE 'I YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR L � ' � : � � �N ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEME
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value excee 00, 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 approve nd a reinspection fee will be charged.
Owner or Agent
The foregoing instrument was acknowledged before me this 27
day of ' ,20 11 ,by
Signs
Contractor
The foregoing instrument was acknowledged before me this c18
I4 ' /,20 1,by n'91 9:: ?^ ICart,
r who has produced
on and who did take
who ispersonally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
APPROVED BY
(Revised 07 /10 /07XRevised 06/10/2009)
Plans Examiner
Engineer
NOTARY PUBLIC:
Sign:
Print: U
My Commission Expires: '4\2 ,12,o1
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AWSPIKIMPospip
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Zoning
Clerk checked