EL-07-113BUILDING
Miami Shores Village
Building Department
JAN 2, ��? 2001
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972 1 '�
Permit No. C 0j ~J1
PERMIT APPLICATION
FBC 2004
Permit Type (circle): Building
Owner's Name (Fee Simple Titleholder)
Owner's Address / Z5/
City h rq vw t 51i,Aftst5 State
Tenant/Lessee Name
Electrical
Master Permit No.
Plumbing Mechanical Roofing
Phone # 8�3 7
it
Zip
Phone #
Job Address (where the work is being done)
City
FOLIO / PARCEL #
Miami Shores Village
County Miami -Dade
Zip
Is Building Historically Designated YES
Contractor's Company Name
Contractor's Address / 3/ 5- evrui )0
City
Qualifier Name
�S
(
Phone # 31o5—z '7)12_
State Certificate or Registration No.
Architect/Engineer's Name (if applicable)
Zip
hone # 301" of ‘d- i 7 }c2_
Certificate of •y' tency No. Cc-Woo/72:43
Alonee #
Value of Work For this Permit $ 5-30.
Type of Work: [Addition [Alteration
Describe Work: _ /g`L.
Square / Linear Footage Of Work:
[New
Repair/Replace 0 Demolition
4
** *, , * * * *,r * * * * * *,r,r * * * * *** * * ***** ** Fees, ****** a******* * * * * **** * * * * *** * * * *,r * * * * * * * ***
CCF $ a O CO /CC
Notary $ Training/Education Fee $ c 20 Technology Fee $
Scanning $ Radon $
Submittal Fee $ Permit Fee $
DPBR $ Zoning $
Bond $ Code Enforcement $
Structural Review. $
Double Fee $
Total Fee Now Due $ 151-5S
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 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 i
r—
Signatur
Owner or Agent
The for - going instrument was acknowledged before me
day of Jp orr, 200 3-, by
who is personally known to me or who has produced \J�,
As identification and who did take an °i as identification and who did take an oath.
NOTARY PUBLIC: Lucy
0:40:• My
6 DD323502
Expires May 28, 2008
Signature
ntractor
The foregoing instrument was acknowledged before me this 23
day of , ( eg4/C/ , 200 ?- by
who is personally known to me or who has produced
Sign:
Print: ataUC. 7,6v 7,O S
My Commission Expires: )y1 C e7 (p , zoo 5
NOTARY PUBLIC: It Lucy Burgos
My Commission DD323502
a° Expires May 28, 2008
#vim
Sign:
Print:
13(ilelS
My Commission Expires: /n�,
� _
APPLICATION APPROVED BY: // - . _ f _ ��,e.- eok Plans Examiner
Engineer
Zoning
(Revised 02/08/06)