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PT-07-29Miami 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 2004 IlEOMEV9 JAN 0 8 MP !J Permit NoQ 1 :fir 9 Master Permit No. Permit Type (circle): Buildin Electrical P1, bing Mechanical Roofing . J Owner' s Name (Fee Simple Titleholder ) /v1112 Phone # .� ©S �— � �� —/ ca a 7 Owner's Address 5'% ,4J&) /0(7%0 city M Tenant/Lessee Name it// Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # 3'f Zip 33 ( Phone # it14 focpre County Miami -Dade Zip 33151 Is Building Historically Designated YES NO Contractor's Company Name Contractor's Address . Phone # City State Zip Qualifier Name Phone State Certificate or Registration No. Certificate of Comptency No. Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $/lJ°'l.J0- Type of Work: DAddition Describe Work: Square / Linear Footage Of Work: Alteration [New 15, 1. ❑ Demolition ** * * * **** * ** * *** *** **** ***** * * * ** *****Fees*** * * ** * ***** r * * * * ******** ** * * *** * * * ** Ys Submittal Fee $ Permit Fee $ C./ f� '' CCF $ CO /CC Notary $ 6,00 Training/Education Fee $ 0 '2.13 Technology Fee $ Zoning $ Scanning $ Radon $ DPBR $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ C07' 0 See Reverse side —* Bonding Company's Name (if applicable) N/4- Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) ,4// jf 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 IMPROVEMENT_ S TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LEND + R OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to thelissua ce of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the nb�ij bf commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment AlrsoVa�-certzed copy of the recorded notice of commencement must be posted at the job site for the first inspec < which occurs sevenn' 7» ays after the building permit is issued. In the absence of such posted notice, the inspection will be © roved and a reins �`� p pp p�cta ee will be charged. Signature or Agen The foregoing instrument was ac wledged day of , 2(01, by r who is personally known to me or who has pro Signature Contractor e foregoing instrument was acknowledged before me this day of ,20 ,by who is personally known to me or who has produced 5- 5 As identification and who did take an oath. as identification and who did take an oath. NOTARY Sign: Print: My Co 1 ission Expires: * * * * ** NOTARY PUBLIC: Sign: Print: My Commission Expires: * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: (Revised 02/08/06) /07 Plans Examiner Engineer Zoning