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PT-07-201Miami 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 _ ©MEW -TB 0 2 2007 3 Y _ __ - -- Permit NSF 101 O I Master Permit No. Permit Type (circle): Building Electrical Plumbing Owner's Name (Fee Simple Titleholder) re 717/0 ?ley( Owner's Address 6,-.4n41 c -s e City Alm/ S%4'e.S State Zip Tenant/Lessee Name Mechanical Roofing Phone # 3a$ — 7s1- Z5 .5 a3/3 Phone # Job Address (where the work is being done City ✓ Miami Shores Vill FOLIO / PARCEL # 749 044n, ewwadr.n County Miami -D de Zip (,-7°(\ °1111E Is Building Historically Designated YES NO Contractor's Company Name Contractor's Address City State 1-tomei Oumw- Phone # 33!3 Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Square / Linear Footage Of Work: Type of Work: ❑Addition Alteration ['New Describe Work: ❑ Repair/Replace ❑ Demolition 14\.)j Submittal Fee $ Permit Fee $ l0D •( _ Notary $ 6- Training/Education Fee $ 4 �1 i Scanning $ Radon $ Bond $ Code Enforcement $ DPBR $ Double Fee $ CCF $ Q -COO Technology Fee $ 1-57 COICC Zoning $ Structural Review. $ Total Fee Now Due $ [P71)0 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 A}'F1DAVIT: 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 ATTORNE BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an - es 0, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law bro u;dt� livered to the person whose property is subject to attachment. Also, a certified co + of the recorded notice of commencement posted at the job site for the first inspection which occurs seven (7) days after the b ing permit is issued. In the absence of such posted notice, the inspection will not be proved and + '. n fee will be charged. Owner or Agent The fo - going instrument was ac owledged day o who is personally 20CR by m) own to me or who has produced(J2,' 11— 0(iwho is personally known to me or Signature Contractor The foregoing instrumen as acknowledged before me this , day of , 20 by 0011// As identifie Rind who did take an oath. NOTARY '_s : LIC: Sign: Print: My C ission Expires: * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: (Revised 02/08/06) gfa ***********'********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ** o has produced as identification an . who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: Plans Examiner Engineer Zoning