BPP-11-1391Miami 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
PER MAT APPLICATION
FBC 20ki
Permit Type:
OWNER: Name (Fee Simple Titleholder): A 0 L C. c) Phone#:
c�
Address: 2 ) 7 �� 2A-4 %
City: SkAA4 (NSA, State: FL Zip: '3 3 3 2 2
one#:
ROOFING
AUG0 22011
Y
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permitNaVIHIY11_
Master Permit No.
Tenant/Lessee Name:
f
Email: 1 $
r q :y
JOB ADDRESS: 1' l 7 3$ G i t
City:
Miami Shores County:
Miami Dade
zip: 3 3 1 3 1
Folio/Parcel#: 1( ,7 2,0 s a` c Zia d
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name:-03(3, 14e.cirt Cif a1 rv. Phone4 .(Q • --S 1 0
Address: CA 00Q.�
City d Ckryvt., State: P
Qualifier Name: u p a., - • s LUX re
State Certification or Registration 'L. l 9 C- 0.7.,35 2 .' )Certifi
Contact Phone #: Email Ad
DESIGNER: Architect/Engineer:
Zip: l
Value of Work for this Permit: $ 1 0 uare/Linear Footage of Work
Type of Work: UAddition DAlteration &New ORepair/Replace
Description of Work :SC ' , t 0b L /as pc
********** **** *** *** ***aa:*** * * * *** *** ** Fees *** * ******* * * *a * *** ** ******* **** * *** * *** * **
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training /Education Fee $ Technology Fee $
Double Fee $ Structural Review $ 40'
TOTAL FEE NOW DUE $
Company's Name (if applicable)
Boni " r g 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 NOTIC OF COMMENCEMENT."
Notice to Applicant: As a condition to thee� g� r d fro .� it
promise in good faith that a copy of the notice of c
whose property is subject to attachment. Also, a certified co
for the first inspection which occurs seven (7) g
f ji p ()days after the building
inspection will not be approved and a reinspection fee will be charged.
with an estimated value exceeding $2500, the applicant must
tion lien law brochure will be delivered to the person
mmencement must be posted at the job site
In the absence of such posted notice, the
Signature
q144 77• Yom.- .c.c.a
Owner or Agent
The foregoing instrument was acknowledged before me this in
of Co t2O by De i 1 w ee who is personaown to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Si
Print:
My Commission Exp
Contra ' 1
The f reomg instrument was ackn wledged before me this 1
day of J , 20 1 I , by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
MY COMMISSION # 1)1)854166
EXPIRES: January 25, 2013
1,800.3.NO1'ARY P1. Notary Disowns Assoc Co.
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Prm ! CIS. LLi ;/'f' \i "E.010,1,1"' '
Comm. Ex Sep 12.2014
'reoimisoton • EE 25344
Boned Througb Maul ttAny Ana.
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APPROVED BY
(Revised 07110 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Plans Examiner
Structural Review
Zoning
Clerk