DEMO-07-2338tik\ W\ti601
GIN 3
Miami 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 2004
Permit Type (circle):
re,METE3
NOV 1 6 MT JD
BY: (1;""----
Permit No.'" .P/A,O �� ° ®��
Master Permit No.
Electrical Plumbing Mechanical
Owner's Name (Fee Simple Titleholder) /',1 // A s/ !> Phone #
Owner's Address 9oZ /51 sk2 t
City /%/ 4 d/ / State /0 /2 i9 Zip
/r41°
Tenant/Lessee Name
Job Address (where the work is being done
City Miami Shores Village
FOLIO / PARCEL #
Is Building Historically Designated YES
Roofing
.s 772 .68 Zv
L 33�) c?
Phone # /x
9.15-7 , £M®e -�- ,L l �/
County Miami -Dade Z. 1.� O
Contractor's Company Name
Contractor's Address
City State Zip
Qualifier Name Phone #
NO ►A
o, 7 eVL-
Phone #
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
De.. �q �'I Phone #
305 300 94,y
�0 0 0 Square / Linear Footage Of Work: A PAW ar /c2Dgf9
Type of Work: ['Addition DAlteration
Describe Work: .e MQ ✓'-e LL K s
New [' Repair/Replace
e-, 's C.9, / -�-2. 4,
I /v P 7� 5 fl/vd a14aS 04-S 0- fiL NS
Demolition
* * *** * * * * * * *** *** * *** * ** ** * * ** * Fee ** ********** * * * * * *** * ** * * * * ** ** * * * * * * ** * * **
Permit Fee $ 100 �r.0- •
Submittal Fee $
Notary $
Scanning $ Radon $ DPBR $
Bond $ Code Enforcement $ Double Fee $
Pe
Training/Education Fee $
CCF $ CO /CC
Technology Fee $
Zoning $
Structural Review. $
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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IlVIPROVEMENTS 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
promise in good faith that a copy of the notice of commencement and c
=-- 19119R,,r wa jjac ylii fi fgattachment. Also, a cent f ed copy the
whose property is subject to attachment Also, a certified copy
for the first inspection which , seven (7) days after
inspection will not be approv % and a efsppection fee wily r w ed
witt�t3an estimated value exceeding $2500, the applicant must
ion lien law brochure will be delivered to the person
notice of must be posted at the job site
it-141.76 yr n -carom orw.rrire-wrrt aG aeavereaTV me person
orded notice of commencement must be posted at the job site
g permit is issued In the absence of such posted notice, the
Signature
er or Agent®. ' Contractor
The foregoing instrument acknowledge me this V ge The foregoing instrument was acknowledged before me this
day of 'ti 0 v . , 20 ,r f by 244.41 f ri 4A A - t , day of , 20 by
who is . r e to me who has produced who is personally known to me or who has produced
as identification and who did take an oath.
ALINA D. PUIG NOTARY PUBLIC:
r P''e t, Notary Pubic - State of Florida
F % ` 1, 2010 Sign:
` -45 "a p Cornniesion # DD 559118 n. mint:
As identification and who did take an oath.
NOTARY P
Sign:
Print:
LIC:
My Commission Expires: I
'
APPLICATION APPROVED BY:
(Revised 02/08/06)
My Commission Expires:
Plans Examiner
v Engineer
Zoning