EL-05-1028Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores Florida 33138
Tel: ( 8972
BUILDING
PERMIT APPLICATION
FBC 2001
NOV ? ; Permit No. E L S - 1 o2S
Permit Type (circle): Building Plumbing
PCl�i1 6-L v Phone #(3cE) ` T: <— 1401
Owner's Address CI I 0 0 t.) 1-
City t A l S�t-- State i,., Zip (
Owner's Name (Fee Simple Titleholder)
ster Permit No.
Mechanical Roofing
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 9 ‘ ° ts3 ` E
City Miami Shores Villa e County Miami -Dade Zip 6 1 so
Is Building Historically Designated YES NO
Contractor's Company Name T} n.,0'(-- LTl Q,3 L
Contractor's Address _ Z S S t 9 +)" ST
City
Qualifier Yl. C_
Phone # tC5- Std— 3000 yean 013
' Lt7 2 SUITE F•
State Certificate or Registiation No. Ec100 101 0 Certificate of Cmpe n
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit A k,5 Z
Type of Work: ['Addition
Describe Work:
Phone #
Square Footage Of Work:
Iteration []New 0 Repair/Replace 0 Demolition
(' ThLL Prrn 0 t) 0 4t V-b LPL Pit -Pr -H
\ "F E7.. 19 � tL
* * * * * * * * * * * * * * * * * * * * * * * * * * ** e. * *,r * * * ,r * * *** * * * * * * ** * * * * * **
Submittal Fee $ Permit Fee $ CCF $ i • c). 0 CO /CC.
Notary $ Training/Education Fee $ 0 � Technology Fee $
Scanning $ 3 . CO Radon $ Zoning Bond $
Code Enforcement $
Total Fee Now Due S
Structural Plan Review. $
(Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State
Zip
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
The foregoing instrument was acknow)ei me this
day of MO ,20 &by\ a L. mod% ,_
who is personally kA Wn 4S' who has oduced ,D 1,
030 0 - 112:7- s- identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
****************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
��. i DD298875
April 05, 2008
************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY.
chc 05/13/03
Contra tor
The foregoing instrument was acknowledged before me this £ 7
day of A/0 V , 20 (2 by 'G ?.
who is personally know O me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
My Commission Expires:
**************************** * * *** * *,* * * * * * * * * * * * ** * * * * * * * **
riguez
rv• _ DQ088675
�u 8
Plans Examiner
Engineer
Zoning