FW-106-256Miami 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 2001
Master Permit No.
Permit Type (circle): Building Electrical Plumbing
Owner's Name (Fee Simple Titleholder) ?c3'b.Q- &m2
Ownerr' Address Ggd N E ^) S z
1' `
City ;a,r+y S no t`eS State �•
Tenant/Lessee Name
Mechanical Roofing
Phone # 305 - 3n - 11 3 `I
Zip 3 "3 i '3 g`
Phone #
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO
Contractor's Company Name
Phone #
ip
Address
City State Zip
Qualifier
State Certificate or Registration No. (` q 'C'ertificate of Competency No.
J
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit c ,, O
Type of Work: DAddition ['Alteration
Describe Work:
Square Footage Of Work: l '
16 i
5
['New 0 Repair/Replace D Demolition
-e..w -e t\(e- i n bacKyareL
Submittal Fee $ GJ Permit Fee $ CCF $ CO /CC.
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ 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 AIiFIDAVIT: 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose properly is subject to attachment. Also, a certified copp of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after- the building permit is issued In the absence of such posted notice, the
inspection will not be a roved and a reinspection fee will be-charged]
Signature
er or Agent
The foregoing instrument was acknowledged before me this g 1
day of 20 06, by 0 iie/ Oat
ho is �' rsonally known to me or who has produced
/kb' /,, �j� Y p
t$ic L/Q/� As identification and who did take an oath.
Signature
Contractor
The foregoing instrument was * cknowledged 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:
My Commission Expires:
My Commission Expires:
***************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
chc 05 /13/03
* * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning