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PL-07-2459n. \i1A - 'Lff4t1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Plumbing yez sr..® Owner's Name (Fee Simple Titleholder) ` Phone # C.3c>5-) - Owner's Address 92 `a 5 No City�.�4� State C Zip Tenant/Lessee Name Phone # E- MAIL: j-2f � 2 Fc � 5 a , /r�r Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Zip its DEC 0 7 2007 bt BY: Permit No. FLO-7' .2450f Master Permit No. 6S l S ®� FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name ibrvQ/ o Phone # Contractor's Address City State Qualifier Name Zip Phone # State Certificate or Registration No. Certificate of Competency No. E- MAIL: Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 900 Square / Linear Footage Of Work: Type of Work: ❑Addition El Alteration ['New Describe Work: awc P x is t, r■S_ r LsLr ‹air /Replace ['Demolition * * * * * * * ***** ** * * *x, ** ** ***************Fees************************ /5-° 4^ Submittal Fee $ Notary $ S-00 Scanning $ 500 Permit Fee $ Training /Education Fee $ Radon $ DPBR $ Bond $ Code Enforcement * * * * * * * * * * * ** * * * * ** CCF $ �CO/CC Technology Fee $. IJ Structural Review. $ Double Fee $ DEC 13 07 CK 45 Zoning $ Total Fee Now Due $ See Reverse side -4 Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City Zip 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 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 Owner or Agent Signature Contractor The fore oing instrument was acknowledged befor me this The foregoing instrument was acknowledged before me this day of � , 20 al by. 'Jam I Uk. (/� � , day of 20 .,� by tee. „s who is personally known to me or who has produced s identification and who did take ti1o`L,�1 ���'� �0 ylc• as identification and who did take an oath. �SQ,� . �q `V„s'a' �� .s%h, °� • `04'4°4,6 al �„ .,�,. G° � Sign: l�� <;' Print: who is ersonally known to me or who has produced �- „ -00, .,l . NOTARY PUBLIC: Sign: Print: NOTARY PUBLIC: My Commission Expires: * * *xxxxx *x * * * * * * * * ** * * * *dc APPLICATION APPROVE (Revised 02/08/06) ,N My Commission Expires: * *xx•xx *x* * * * * **** '. *********** x *** * * * **xx* ****aYaeaYreFxxxxx* *9:xxxxx /at/or Plans Examiner Engineer Zoning