DS-06-338Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
*-7CE0 ED
BUILDING
PERMIT APPLICATION F�
FBC 2001 -
Permit Type (circle uB i;I g Electrical
2000
Permit No. — 8
Master Permit No.
Plumbing Mechanical Roofing
Owner's (Fee Simple Titleholder) Name (F p ) T tllt,3o ®a &ND ® dS_toe y ' MX, < .Phone #
Owner's Address /330 VC_ / pr A� &'te& L€L3ow>tz, P, .,,.'c,v,-
3t 5 2.1? _ 5 ZQQ
City 011 1 A-N.t f 5 rw 2. State "a-e Zip n, 1
Tenant/Lessee Name S,4nfi Phone #
Job Address (where the work is being done) /370 Ni for sr.
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO �-
Zip 33/38
Contractor's Company Name �`� , Phone #
Contractor's Address
City State Zip
Qualifier
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
51+10. Dm
$ Value of Work For this Permit
Type of Work: DAddition ['Alteration
Describe Work: R.c—r& R. Qatuac paagLT
ONew
Square Footage Of Work:
[VRepair/Replace D Demolition
/Wind& ! 'SE4LC 74T` kgi> p Ie&'I4f toT:
****************************Fees******************************
* * ** ** * * * * * * * * * * * * * * * ** * * * **
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, 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
Signa Algteg
Owner or Agen
The foregoing instrument was ac
day of JCAr\ ,20G,by
foe./ iMe,
ets\
{ledged bef i
re,
who is personally known to me or who has produced
As identification and who did take an oath.
NOTAR
Sign:
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of , 20 __, by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
'.,p.�� Carmen A. Velunza
Print: ryV Pil9
My Com 16.414 Commission # DD461539
MUMS
} macpwes August 28, 2009
APPLICATION APPROVED BY:
chc 05/13/03
My Commission Expires:
Plans Examiner
Engineer
Zoning