PL-04-289Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
E IEO ED
OCT t 7 2004
elm ar me
BUILDING Permit No. fL c 0 ?
PERMIT APPLICATION Master Permit No.
FBC 2001 pulo
Permit Type (circle): Building
Mechanical
Roofing
Owner's Name (Fee Simple Titleholder) f)J' Nev? Phone #
Owner's Address ?70 4.1 e 9 2
City v2 State
Tenant/Lessee Name -- Phone # �' / S 2 j
Zip
Job Address (where the work is being done) y 7 o Are '7 2
City Miami Shores Village
Is Building Historically Designated YES
County Miami -Dade
Contractor's Company Name -re CO
NO
Phone # 360— � 70 f 7c '
Contractor's Address l5 77 CA}
City 4/ /4 V 1 „ tfeq Cqq State d 7 ?
Qualifier S' v S V c 6t- /2
State Certificate or Registration No. cr4, / le
Architect/Engineer's Name (if applicable)
Certificate of Competency No.
Phone #
$ Value of Work For this Permit
0e:;
Type of Work:
Describe Work:
Square Footage Of Work:
pc, Il4 thte. ?L��
['Addition ❑Alteration ❑New ❑ Repair/Replace
MeV( ti<✓ xt'S 74/4, G 44
['Demolition
0(6',
Submittal Fee $ C"n Permit Fee $
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Notary $ TrainingfEducation Fee $
Scanning $ Radon $
CCF $
CO /CC
Technology Fee $
Zoning Bond $
Code Enforcement $ Structural Plan Review. $
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 b i dThg) permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commen ent and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified co of e recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after ting permit is issued. In the absence of such posted notice, the
inspection will not be app an nspection fee will be c&Keiti
•
Signature
O or Agent ..
--Mt
The foregoing instrument was acknowledged before me this Ji ejofgoing ' ent was acknowledged before me this
day of 1) C fC)At, 20 C' 1, by i i41,44,91-61- Ale- , da • � Ti c 20 tai by 7e S ("3 \ QC,, 1 ,
who is personally known to me or who has produced who ' , nally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY' C: NOTARY P
Sign: ,,�aU � ' % Sign:
Print: V. Le q-L Print:
My Commis
ature 3Cleots UDZ&,
Contractor
My Commission Expires:
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7
Li= UONITrft Q
-PO clifIVA
fission ' Dp00490
y Ha Notary Asan,
V
(A)
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LUIS MONTERO
�"► - Notary Public - State of Florida
. Commission t DD054905
"°; „too` Bonded By National Notary Assn,
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APPLICATION APPROVED B
Cho 05/13/03
Plans Examiner
Engineer
Zoning