FW-206-314Miami 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 2001
Permit Type (circle):
CEIVED
� . 6 2006
Permit No. flo-). C6-`314-
Master Permit No.
Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) t Ct c,)
Owner's Address 151 P . la Z STs
City V. i P State
Tenant/Lessee Name
Phone # ?ca 9 -3Z-s3
Zip 33 t 3 B
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
she
County iami -D . de
Contractor's Company Name / ,(J€1e %
Contractor's Address
NO
Phone # 3 as---
Phone #
2S-3
„ tee.
Zip 33/3
City State
Zip
Qualifier
State Certificate or Registration No. ,Certificate-of ompe
Architect/Engineer's Name (if applicable)
Phone #
$ Value of Work For this Permit iSle) s Square Footage Of Work: ` ,/_
Type of Work: ❑Addition
Describe Work:
( 1 k
Alteration ❑New ❑ Repair/Replace ❑ Demolition
S late -� ' ,vv A2J1)
sA #49— ��v'- 4-e---2 42-9.—..
** * **********************Fees******************************
* * * * *, *, * *, Fees, * * * * * * * * * * * * * * * ** *** *x * * ** * **
Submittal Fee $_ Permit Fee $ CCF $ CO /CC.
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ Zoning Bond $
Code Enforcement $
Structural Plan Review. $
Total Fee Now Due $
(Continued on opposite 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, certifie ' ' Ty of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven i days ' r the building permit is issued In the absence of such posted notice, the
inspection will not be appr %ved and a rei Lion "e >ill be charged
Signature
Signattlye
Owner or A ent Contractor.
The foregoin instrument was acknowledged before me this • The foregoing instrument was acknowledged before me this
day of • , 20 , by �-'" Jd , day of , 20 by
who is personally known to me or who has produced iigkeiir, is personally known to me or who has produced
'4 4'36 -(‘ I° 2.fgAs identification and who did take au oath. as identification and who did take an oath.
NOTARY P
Sign:
Print:
Y PUBLIC:
Sign:
Print:
My Commission Expires: My Commission Expires:
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY: Plans Examiner
chc 05/13/03
Engineer
4'9 /;k6- Zoning