PT-07-540Miami 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
Permit Type (circle
Owner's Name {Fee _�,_ -,.
10395 NE 12 AVE.
Owner's Address
Electrical
Permit No.
MAR 1 9 2007 H
Master Permit No.
Plumbing Mechanical Roofing
Phone # 305 - 757 -1823
City MIAMI SHORES State FL
Tenant/Lessee Name.
Zip
Phone #
Job Address (where the work is being done) 10395 NE 12 AVE .
City Miami Shores Village
County Miami -Dade
FOLIO / PARCEL # 1122 3203 000 60
Zip 33138
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's Address
City MIAMI
Qualifier Name Phone #
Ben Pumo, Owner
Phone # 305- 757 -1823
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) None
Value of Work For this Permit $ 750.00
Type of Work: ['Addition ['Alteration
Describe Work: paint outside of house
Phone #
Square /Linear Footage Of Work:
New ® Repair/Replace
❑ Demolition
Submittal Fee $ Permit Fee $
Notary $ Training/Education Fee $ 0 .20
Scanning $ Radon $ DPBR $
Bond $ Code Enforcement $ Double Fee $
CCF $ (J `,J CO /CC
Technology Fee $
Zoning $
Structural Review. $ Total Fee Now Due $ (02'
See Reverse side -->
Bonding Company's Name (if applicable)
Bonding Company's Address
City
N/A
N/A
State
Zip
Mortgage Lender's Name (if applicable) N/A
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 vale c 00, the applicant must
promise in good faith that a copy of the notice of commencem c *for2R1 elivered to the person
whose property is subject to attachment. Also, a certified copy k Ka,, ' e posted at the job site
for the first inspection which occurs seven (7) days after the 6..'f"• - Is issued. In the absence of such posted notice, the
aJ' .�
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this
day of March , 20 07 , by Ben Pumo
ho is personally known)o me or who has produced
As identification and who did take an oath.
enteataavc Owner
16 th The foregoing instrument was acknowledged before me this 16 th
, day of March , 20 07 , by Ben Pumo
(who is personally to me or who has produced
as identification and who did take an oath.
NO;c'ARY PUBLIC:
444 Ardi
Sign:
01o� *Z",,, GARIDAD MORALES
* t_� * MY COMMISSION # DD 447774
- EXPIRES: September 7, 2009
�-f
, oe° Bled Thru Budget Notary Services
Print: Caridad Morales
My Commission Expires:
APPLICATION APPROVED BY:
(Revised 02/08/06)
NOTARY PUBLIC: 4,2N , GARIDAD MORALES
t * MY COMMISSION # DD 447774
EXPIRES: September 7, 2009
et Notary Services
Sign:
Print:
Caridad Morales
My Commission Expires:
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Plans Examiner
Engineer
Zoning