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RF-06-12214')V11,2 {0(0 BUILDING Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 FFax:(3Os 756.8972 1 2006 PERMIT APPLICATION FBC 2001 BY: Permit Type (circle): Building Elec c Plumbing Mechanical Owner's Name (Fee Simple Titleholder) Owner's Address -' _- City Tenant/Lessee Name Phone #hr_ Job Address (where the work is being done) 6 f5 City Miami Shores Village County Miami -Dade Is Building Historically Designated YES NO Contractor's Company Name /9/61--0//- 22a? Contractor's Address /0 Zip.' J City P n/4-� / tate Zip 2? %6r State Certificate or Registration No. cc` CO-5---?9,06. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit /00 Type of Work DAdditiori DAlteration Describe Work' ! L< 9 Z. Square Footage Of Work: . SG7. * * * **** * *** * * ** ************Fees****************************** Submittal Fee $ Permit Fee $ /06 CCF$ 1' , CO /CC Technology Fee $ c� Scanning $ Radon $ Zoning Bond $ Notary $ Training/Education Fee $ V .( ) Code Enforcement $ Structural Nan Review. $ Total Fee Now Due $ a go (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 issu promise in good faith that a copy e whose property is subject to attac/ l lestimated value exceeding $2500, the applicant must lruction lien law brochure will be delivered to the person � s1"ed -co y jthe recorded notice of commencement must be posted at the job site for the first inspection which occhxrs -seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature` Owner or Agent The foregoing, *nstrument was acknowledged be 20 04 by Contractor ore e thist The for. oing ? strument was acknowledged before me this _/ 5'A, ' day of 20 by o me or who has produced who is ers � all kn wn _ ye or w o has produced d "V • A� As identific , t.. I My Conunission Expires: OTARY PUB Sign: Print: My Commission Expires: APPLICATION APPROVED BY: Plans Examiner Engineer Zoning chc 05/13/03 "t s - '1∎1;s *c vzs' 4Dco '2,2. 1