BPP-10-187511116 10-140fitliv
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
paMgVZ
OCT 2 5 2010
Permit No. oP13 ID-16`15
Master Permit No.
Permit yptt ROOFING
OOFING —,�
Owner's Name (Fee Simple Titleholder) �. L L1 fl : -l`��
L" 4 1
Phone # ' 1
' t tit)) �� ,� ,,,1 « u'_ .
Owner's Address � - � °
City , 2i,�Il�+ `>,7)t \L' State
Tenant/Lessee Name
Email
Job Address (where the work is being done) 1 IQ, ''E? i\1 i (e\
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL # . i,) ` '`2 ` —C/0 i ®L , C
Is Building Historically Designated YES NO
Contractor's Company Name kit c a (\L 1 ape ° 1)0 o C
ica3 kik) Lek f
Contractor's Address
City
Qualifier Name
State Certificate or Registration No. C VC i C> Certifica
Contact Phone C E ` g �,j ' ( G,, Lq E -mail }- ODimA ,
Flood Zone
Toone # 54- (e l
Zip: ?&G
hie # 618 -16426
Architect/Engineer's Name (if applicable) L k ki tAt..1 Phone #
Value of Work For this Permit $ (f
Type of Work: ['Addition ❑Alteration
Describe Work: ( c
01.E t?a
❑ Demolition
Square / Linear Footage Of Work:
Lr21 qu� w ❑ Repair/Replace
Otti foci,
f-
'/dit ® 1****** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * ** * * * * * * * * * * * * * **
Submittal Fee $ 1S0'0 Permit Fee $ CCF $ CO /CC $
Notary $
Scanning $
Double Fee $
Training/Education Fee $
DPBR $
Violation date:
Radon $
Structural Review. $ 1
Technology Fee $
Bond $
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 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 1
whose property is subject to attachment. Also, a certified copy of the recorded notice o
for the first inspection which occurs seven (7) days after the building permit is •
inspection will not be approved and a reinspection fee will be charged.
Signature
497
ure will be delivered to the person
ement must be posted at the job site
he absence of such posted notice, the
Owner or Agent / Contractor
The foregoing instrument was acknowledged before me .': The foregoing instrument was acknowledged before me this
day of 0 , 20, by b 'e�i■ i a r C-O day of
who is personally known to me or who has produced who is personally known to me or who has produced
as identification and who did take an oath.
, 20 la, by ,``'t".\ 51,4,4
As % dentification and who did take an oath.
NOTARY PUB
Sign:
Print:
My Commission Expires: # t:
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4t, A
* COMMISSION OD
EXPIRES: Juni 20, 2013
''"oz. Foe Banded ruu !Wet Wiry Sentas
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NOTARY PUBL'C:
SIN E HU�LI
ta
- Ste of Flom
C 0793483
APPROVED BY
Plans Examiner
Engineer
(Revised 07 /10 /07)(Revised 06/10/2009)
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Zoning
Clerk checked