RF-11-1666LI 5 it
UILDING
PERMIT APPLICATION
Miami Shores Village ram" Building Department Ep0 9 7017
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949, n
Permit No. 1 1 ` l W
(0VJ
Master Permit No.
FBC 20
Permit Type: BUILDING ROOFING
Owner's Name (Fee Simple Titleholder) Michael Longman Phone # ( 786) 972 -1 361
Owner's Address 844 N.E. 98 Street
City Miami Shores State Fl Zip 33138
Tenant/Lessee Name e #
Email
Job Address (where the work is being done) 844•
City Miami Shores Village
FOLIO / PARCEL # 1 1— 3 2 0 6— 0
Is Building Historically Designated YES'
NO X
Contractor's CompanyNameQuality Roofing Contractor
Contractor's Address 13 8 0 0 N.W. 1 st Avenue
City Miami State''
Qualifier Name Carlos Arocho
State Certificate or Registration No. RGO 0 5 8 6 2 7
Contact Phone
Flood Zone
Phone# (305) 953 -3333
Carlos or Marylou
1 Zip 33168
Phone# (786) 367 -2029
Certificate of Competency No. 0 0 0 01 7 8 8 9
E-mail qualityroofing88 @yahoo.com
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ 1 , 0 0 0.0 0
Type of Work: ❑Addition DAlteration
Describe Work:
Square / Linear Footage Of Work: 1 / 2 sqf t
['New Ei Repair/Replace [' Demolition
Repair leAK at valley tie in.
Submittal Fee $ Permit Fee $
Notary $
Scanning $ Radon $
Double Fee $
Structural Review. $
J
CCF $ CO /CC $
Training/Education Fee $ Technology Fee $
DPBR $ Bond $
Violation date:
Total Fee Now Due $
See Reverse 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. i
"WARNING TO OWNER: YOUR ' '';'O 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
promise in good faith that a copy of the notice of co
whose property is subject to attachment. Also, a certi
for the first inspection which occurs seven (7) days after
*ding permit with an estimated value exceeding $2500, the applicant must
m nt and construction lien law brochure will be delivered to the person
f he recorded notice of commencement must be posted at the job site
g permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be c r
Signature1 — /vti<-r
Owner or Agent
The foregoing instrument was acknowledged before me this 30
day of 200_, by ,L 1,'t rr►.�+.n.
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign: JJ yy
Print: ( 1 c,11 Vv l l e r de_r -a7 _
My Commission Expires: `(0 3 •
l ru
Notary r'ublic State 01 Flo12
Michelle Perez
My Commiaair fl FF009808
Expires 0 410812 01 3
Contractor
The foregoing was acknowledged before me this.av
day of 20 Ft , by e,,f.1,,, - ,
who is person known to me or who has produced
as identification and who did take an oath.
zgto picalloa nLN'V LLV mut a5W Oti
My Commission Expiret:I0c `01 ',L00 :sa.ndxa e** ,
91700£6QQ# uotsstUiulo - '• �" °
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APPROVED BY `41
Plans Examiner Zoning
Engineer Clerk checked
(Revised 07 /10 /07)(Revised 06/10/2009)