RC-06-690Miami Shores Village
Building Department
BUILDING
PERMIT APPLI ! TIO
FBC 2001
es, Florida 33138
) 756.8972
Permit No. FC
Master Permit No.
Permit Type (circle
Roofing
Owner's (Fee ' s Name � Sim ,
p ' 6(44Aiv ��=� hone #
Owner's Address clo 4 i JU
City M Lit State FLVEt- E/04---
Tenant/Lessee Name •-)
FTA
t'
Zip :313e)
Job Address (where the work is being done) "l 0 WE� l•-' 44't
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO X
Contractor's Company Name v L.. -'i— -e f
Contractor's Address
City
Qualifier
Phone #
Zip Sa
,State
Zip
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Cam - Sunkorif..49 Phone #c 3 .g) 0'15 ®1 2.
$ Value of Work For this Permit : 60t 000 &Iua�-e FU ota e Of Work: (41k0 _ i *J�
Type of Work: Addition �I Alteration > []New j2r Repair/Replace Demolition
Describe Work: etas il s t . -Gem✓ '51 .r' "mi c c(,S'r� N i era , -
uz• 1 a.'Tertxxx: Ti ficLls Ariv 0 via-S' Thkireo 0 t-a-cra ' C—
J''C1CAhCIJ . izgz22 ratng''fT d t- icks (a. root, . 1-0=errbvtd
ihrOitemet. iikL elciPp itd i. t z— .rat . az —0m1-1#.1 lam' Yrtero'(.
(4,&44. ,C=c75 * *** * * * * * * * ** * * ** * ** ** *** *** Fees * * * ** * * * * * * * * * * ** * * ** * * *** * * **
Submittal Fee $ • OO Permit Fee $ CCF $ CO /CC.
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $ 50. By `I'
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 approve# and a reinspection fee will be charged
Signature
Owner or Agent
The foregoing instrument was acknowledged before-me this, gip`
day of Ma«ifl , 2004 , by 116N 01l' f Qr
Signature
who is personally known to me or who has produced 1 t DL.
" ®As identification and who did take an oath.
NOTAR
Si
Contractor
e 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 Iry 0, Print:
My Commission Expires: kl ' Zd� C7 My Commission Expires:
*************,***** * *,* * * * * * * * * * * * * * ** * ** * ** ** * * ** *, * * *, * * *, , * * * * * * *, * * *, ******* * ** * * * *** * * ** * ** *** * * * * * *,* * * **
APPLICATION APPROVED BY:
chc 05/13/03
Plans Examiner
Engineer
Zoning
Notary Pubic - Stated Florldr
�_Ihly Commission Expires Jan 19, 2010
4. Commission # DD 508988
1 ' "°,, ,, Bonded By National Notary Ann.