DS-11-1484AOt\‘■ o. (04 (LLJ
BUILDING
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
Permit No. OS
PERMIT APPLICATION
FBC 20
Permit
BUILDIN
ROOFING
ZgEM73j11
AUG 1 2 2011
1H44
Master Permit No.
OWNER: Name (Fee Simple Titleholder): Cn alesiVa -T Phone ! i i ‘°k —' 3,` 6
Address: is k S . c 4 c
City: INV. c�.+v,� SN-104-+. - State:
Tenant/Lessee Name:
Zip:
Phone#:
City:
Folio/Parcel #:
Is the Building Historically Designated: Yes
Flood Zone:
CONTRACTOR: Company Name: %T4n'� NAT1 Luc. Phone#(44)
Address: 3I)1 Sw 1%V, 11.1
City: 1% t. '(••' 0r4" • State:
Qualifier Name:
State Certification or Registration #: C.
Contact Phone#T ' � t (.0` 0
DESIGNER: Architect/Engineer:
Zip: 31 UW1
Phone#\gs``) 1— Li'- 11)
Certificate of Competency #:
Phone#:
Value of Work for this Permit: $ 1 �1%41-4'' (5‘' Sq
Type of Work: °Addition °Alteration ❑New
Description of Work: •.Q\ h c.-t_ 'may C 4-4.'‘ V Z
wR-c, Cow .
e of Work: `a '100 m
air/Replace °Demolition
Dv) CZ:s, W,... 4-0
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 $
k
Eopding Company's Name (if applicable)
Bonding Company's ess
City
State
Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's s
City State Zip
Application is hereby made to obtain a permit to do the wo
commenced prior to the issuance of a permit and that
construction in this jurisdiction. I understand that a separate
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS
d installations as indicated. I certify that no work or installation has
ill be performed to meet the standards of all laws regulating
secured for ELECTRICAL WORK, PLUMBING, SIGNS,
ITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is
applicable laws regulating construction and zoning.
4a all work will be done in compliance with all
"WARNING TO OWNER: YOUR FAILURE TO A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PA ` 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
e posted at the job site
uch posted notice, the
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must
for the first inspection which occurs seve r . • sued In abse e o
inspection will not be approved and a reins
Signature
wAialibMitairtgte of Florida
17. Theresa D'Alessandro
as My Commission DD833815
or Expires 10/28/2012.
Owner or Agent
The foregoing instrument was acknowledged before
day of U , 20! i 1 ,by
who is pei
sonally
Contractor
foregoing instrument was acknowledged before me this { 11
201_, by1 te . .64. a. IlO
or who has produced
h . did take an oath.
r who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Notary Public State of Florida
Theresa D'Alessandro
oa My Commission DD833815
d'' xoir 0/26 ' 12
t:
My Commission Expires: )O I ;{
/,20 V'
APPROVED BY Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09)
NOTARY PUB
1
Si
Print: [ i €, Q AG. 1 /
My Commission Expires: 0 L jc2.010
Notary Public State of Florida
Theresa D'Alessandro
y Commission DD833815
pires 10/26/2 1 12
Zoning
Clerk