DS-12-888BUILDING
Miami Shores Village ���
MAY 1 7 2612 ,yi�
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 B Y:
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit No. 0 4.9--
PERMIT APPLICATION Master Permit No. Ci �.°- . �
FBC 20 it) csmt .5A, A0-'` tkt,\N.A , kcAL !kW
Permit Type: BUILDING ROOFING
OWNER: Name (Fee Simple Titleholder): ��rt- ` U ‘N(Y 1 Phone #: 306-1M - 3o50
Address: 1\300 K . �� L _
City: KVe�1 c State: w' Zip: 311k9 k
Phone#: PS- V 3
Tenant/Lessee Name: p � Vt\tttALC-6
Email: e,c\A.1P-c-N5 a` l dN 'O&s- y 1 kh-
JOB ADDRESS: 1\
•
City: Miami Shores j County: Miami Dade
7.1 c
Folio/Parcel #: �I � t, 00000L\O
Is the Building Historically Designated: Yes
CONTRACTOR: Company Name: 4r)WrM
Address:
City: I
6t 4 IN
Qualifier Name: M qr IL . �r
State Certification or Re 'stration #:.A. UC!. 04 e 3300
Contact Phone #: (q.t') 2--7S- -B9 0 Email Address:
DESIGNER: Architect/Engineer:
w
NO
x
Flood Zone:
n j AJ?P(; A7 / v4 LQP Phone#: (30S 9
State: ` lC%t 1dCi Zip:
Phone#: (Sq Z7S Jr�Il
ertificate of Competency #:
Ghdeorp.Cc'�m
Phone#:
Value of Work for this Permit. $ if} 03 Square/Linear
Type of Work: ❑Addition DAlteration ❑New ORep
Description of Work: VM11.M 1aaCe 1,400 4. \ C �-� e.
ork:
ODemolition
******** ** * * * *** * * * * * * * * * * * * * * ** * * * * * ** Fees************* * * ** * * * * ** * * * * * * * * * * * * * * * * * * * **
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 $
$ondiing 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 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 t 4pplicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promis good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose rty 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 r'i a reinspection fee will be charged.
Owner or Agent' �� �, ' ontractor
The foregoing instrument was acknowledged before me this / The foregoing ins . . " ' as acknowledged before me this
day of , ,,( 20 IA by , day of ( 10 , 2011 by Mal C6,1.p
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Print:
My Commission Expir
* * * * * * * * * * * * * * * * **
J� a,
tosty
?0 = Notary Public - State of Florida
My Comm. Expires Jul 6, 2014
, „ 4tr Commission # DO 972411
'.7dir ro Bonded Through National Notary Assn.
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
sellSi _.
Print: Dde0j L.S.011 ch ov ei-ho
My Commission Expires: 0.00 Pok coALY SANCHOYERTO
• * MY COMMISSION # EE 188308
�� EXPIRES: June 5, 2015
****** *** ** * *** **** * * *** ** * *' , "'., A'Oervives
APPROVED BY Plans Examiner
Structural Review
(Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09)
Zoning
Clerk