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PT-07-412Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATIO FBC 2004 Permit Type (circle): Owner's Name (Fee Simple Ti Owner's Address 3 City, Tenant/Lessee Name momrumi MAR 0 2 2007 BY: BIM, (A .• ocgb-ii; Permit No. cc 11 I4%2 Master Permit No. Electrical Plumbing Mechanical Roofing J. dc5A Phone # 305— 75-6 046 State ''7 Zip 3 3 / 438 Phone # -- -- Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # Is Building Historically Designated 4-69 County Miami -D 5 97 YES Contractor's Company Name CX,tJ► t Contractor's Address zip s*-Wsb )0 Phone # City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Square / Linear Footage Of Work: Type of Work: ❑Addition ❑Altera Describe Work: 7A1'A1 r W 4 ew ❑ Repair/Replace ❑ Demolition dr— ********* ** * **** * * * * * * * * ****** ** * * * * * * *F Fees************* * ** * * * * * * * * * *** * *** * * * * * * * * * * ** Submittal Fee $ Permit Fee $ (4;49 "00 CCF $ 0'00 CO /CC Notary $ Training/Education Fee $ ©• ice.) Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side --> Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Inder Name (if,aplicable) 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 A1414 '11)AVIT: 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. Ct l 5►�i _ 1 LENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY:tg • . • ND TO OB'T`AIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING -YOUR-1 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 ap.: ed and a reinspection fee will be charged Signature •s / Signature Owne or Agent Contractor The foregoing instrument was acknowledged before me this , The foregoing instrument was acknowledged before me this day of 44rat , 20 ®l, by aditi._ i t Tod, Vd , day of who isperonally known to me or who has produced f 0, .) J') C l�who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. , 20 , by NOTARY PUBLIC: Sign: Print: My Commission Expires: ******* * * * ***** * * ** ** ** * * * * * ** ** * * * * ** APPLICATION APPROVED BY: (Revised 02/08/06) My Commission Expires: *************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer ��� Zoning