DEMO-10-2076Miami 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
NOV 2&2010
BUILDING Permit No.`?�
PERMIT APPLICATION
FBC 20
Permit Type: BUILDING
OWNER: Name (Fee Simple Titleholder): C ( e V"- �:,'t s m 6� N �' �y Phone #: �� �� 1 Z�
Address: t3 p( L 0
City: `l 4, eLL,.L.t t SL: Ci State: C k Zip:
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: 1 . e\ A. i k"-2._
City: Miami Shores County: Miami Dade Zip: 3 3 tS 0
Folio/Parcel #:
Master Permit No. /0 °-
Is the Building Historically Designated: Yes
NO i//'
Flood Zone:
CONTRACTOR: Compan Name: V' `-- ' ' Cf 0 Phone #: `d �t J
Address: 2 �` -I 1cl _ 1� Z
City: 1?-t " ��''-f [C- Stake: Zip: U 0 Ct
Qualifier Name: "1 z- "L �-"ts
State Certification or Registration #: C Cd r; '3494' 5 P c _ � Certificate of Competency #:
Contact Phone #: - _ S. — -' °V—O 7-7 Email Address: �'1 c- °
) / ' "-' -
DESIGNER: Architect/Engineer: Phone #:
Phone #: Ek-f
Value of Work for this Permit: $ Z-T7 C-i Square/Linear Footage of Work:
Type of Work: DAddress DAlteration New
Description of Work: `'v —e \k"--1.° `,-- 1_ 1/4.3.--4_ ��
DRepair/Replace ►a- aemolition
COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by:
Submittal Fee $ Permit Fee $ t CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $
Technology Fee $
Structural Review $
TOTAL FEE NOW DUE $
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, BOIT.FRS, 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. 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 v
Owner or Agent
The foregoing instrument was acknowledged before me this Z 3 The foregoing instrument was acknowledged before me this
day of ,& 0 e) , 20 0 , by , day of JO ',e) _ , 20 i 0, by
who is per al to me or who has produced who is p sonally 1 n to me or who has produced
as identification and who did take an oath.
Signature
Contractor
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: a-U C�
0--, 4c--'.--`
r °'-'".'.'N LAUR FARLEY
* Y s * MY COMMISSION # DD 646761
s,.. o= EXPIRES: March 16, 2011
9 OFFtoe. Bonded Thar Budget Notary Services
My Commission Expires:
NOTARY PUBLIC:
Sign:
Print:
My omst x
*
40F AS
LAURA'FARLEY
MY COMMISSION # DD 646761
EXPIRES: March 16, 2011
BandedTtuu Budget Notary Setvices
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APPROVED BY
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10)
Plans Examiner
Structural Review
Zoning
Clerk