RF-07-2083Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
OCT MCIEEVE
ilit 1 0 2001
BY:'
BUILDING i�" i 510i Permit No. aomica,
PERMIT APPLICATION eluvl, Master Permit No.
FBC 2004
Permit Type (circle):
Roofmg
Owner's Name (Fee Simple Titleholder) M/' id) ) 1T) r/'7
Owner's Address /0( ( ga /1-76- /40 ,� , J
City 4.1.l07/ ShDle S State %ori C 1
Phone #305- q642- - S
Zip 33 1,30
Tenant/Lessee Name Phone #
Job Address (where the work is being done) /06 c2
City Miami Shores Village
FOLIO / PARCEL #
Is Building Historically Designated YES NO
105 /
zip 33/3g
Contractor's Company Name T h(Q%-412)1' 0 -615-0.
Contractor's Address /5 ) 3 S pLace
¢ )
City w / Q State Zip 5 30 / `�
Qualifier Name )eL 11e7—(n9 /i� Phone 0 - ��j'- 5 -1 a
State Certificate or Registration No. Certificate of Competency No. 0 / 7()O (In-
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ / 150.
Square /
inear.Footage Of Work:
Type of Work: ['Addition ['Alteration ew Repair/Replace ['Demolition
Describe Work:
42-01S7/0/04M Mgrs 49 Y .,7Es.
****** :: **************** *************** Fees****************** *** * * ****+x**+x******* ** ****
Submittal Fee $ Permit Fee $ / Q 0 " CCF $ c (O 0 �Cc.. CC
Notary $ J i`O Training/Education Fee $ ■ 2.0 Technology Fee $2.. C�V
Scanning $ t 00 Radon $ ' DPBR $ Zoning $ 1
Bond $ Code Enforcement $ Double Fee $ I j
Structural Review. $ Total Fee Now Due $ l ` `. (J\/
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 law brochure will be delivered to the person
whose property is subject to attachment. Also, a ce
for the first inspection which occurs seven (7) d�
inspection will noobje approved and a reinspectionYee4i
ed copy of the recorded notice of commencement must be posted at the job site
er the building permit is issued. In the absence of such posted notice, the
e charged
Signature'
Owner or Agent
The fore o'� : instrument was
day o t d:' ,
why s personally known to me or who has produced'
-
NOTARY PUBLIC:
,/)
owled ed before m
, 20M , by aYOi IA AkIS� 1
who
As identification and who did �Q�ti
t, %� ejb /
regoing instrument was acknowledged before me this �9
, 20Qom, b ? i,,e/.J'/,oryne /tha
known to me or who has produced AZ
as identificaj oy*TfliS140hf,
Sign:
Print:
My Commission Expires:
NOTARY PUBLIC:
`Je nandez
Coin -ifs n #DD531762
7 � &
MA. 22, 2010
_di � ell"
! j, dedd `t mu nuv i; c Bonding Co., Inc.
Sign: ∎
Prin
My Commission Expires:
* ** * * * * **
APPLICATION APPROVED BY:
(Revised 07/10/07)
10/
Plans Examiner
Engineer
Zoning