PT-07-391Miami Shores Village °�l�
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
IMUMEWE
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BUILDING hII Permit No. '6C(- I
PERMIT APPLICATION FEB a007
FBC 2004 BY:
Permit Type (circle):
Master Permit No.
Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple - older) t, V f a/t l h t S Phone #
Owner's L s Address ` I t, N E 'Q -3 r of
K �v° 4
City 1 i � L r1. 4 State
Zip
Tenant/Lessee Name
Job Address (where the work is being done
City Miami Shores Village
FOLIO / PARCEL #
Is Building Historically Designated YES NO
County Miami -Dade
Zip
Contractor's Company Name %ne V
Contractor's Address
Phone #
City State
Zip
Qualifier Name Phone #
State Certificate or Registration No. Certificate of Competency No.
ECt
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $ �i FO, Q U
Square / Linear Footage Of Work:
Type of Work: ['Addition ❑Alteration �`Tew
Describe Work:
❑ Repair/Replace ❑ Demolition
J %.L a cCt.. S G\ C� b0 r'O'�
Submittal Fee $
Notary $ 0'60
Scanning $
Bond
Permit Fee $ /Q . CCF $ t�• �a CO /CC
Training/Education Fee $ 0.20
Technology Fee $ / • SO
Radon $ DPBR $ Zoning $
$ Code Enforcement $ Double Fee $
Total Fee Now Due $
Structural Review. $
See Reverse side -3
Y PAID
Li 30
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 ,QR r e
COMMENCEMENT." l� RE
F .� CORDING YOUR NOTICE OF
' 1 _ 1_
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. # reinspection fee will be charged.
Signature Signature
er or Agent Contractor
The foregoing instrument was acknowledged before me this 9_0 The foregoing instrument was acknowledged before me this
day of 1t , 20 01, by Eva hiVd4 L,.S , day of , 20 , by ,
/who is personally known to me or who has produced 6 ►vgj!5 who is personally known to me or who has produced
lo, d S D As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
*** ** **** ** * *********** * **** **** **** *** ***** ** *** * *******,t****** *** * * * * * * * *** ** *** ** * ** *,rat * ***** **** **
APPLICATION APPROVED BY:
(Revised 02/08/06)
Plans Examiner
Engineer
Zoning