Loading...
CC-07-1848 1Z4101 Miami Shores Village XOTC97m Building Department AUG 3 0 2007 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 e �.s Tell 305 795.2204 Fax: 305 B... --' °'.se.• '756.8972 �' BUILDING Permit No. C,(;jCn" l b4 b PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type(circ Building lectrical Plumbing Mechanical Roofing i�q � Owner's Name(Fee Sim Ile Titleholder) �'v`i a vat' c3�oles C/ °� Phone# Owner's Address °f J'® a �2'� .•� L(o�� f' ( 3 3 1 3$'' City 1 d -IA `�' Zip ? /-39 Tenant/Lessee Name ./f� .� Phone## Job Address where e WOO ( the work�being done) City Miami Sh res Village County Miami-Dade ip i FOLIO/PARCEL# Is Building Historically Designated YES NO Contractor's Company N une ® 14 Q d do�pw C,6C I Phone# Contractor's Address `9 _f-e- -�' i City Vl c' Ec �"� State i' L Zip 3 l `5 Qualifier Name T-e $ ( ,S Q(a Z q V Phone# 7 e State Certificate or Registr ition No. CG C / 0 S Z OJ Certificate of Competency No. �© � Arc hitect/Engmeer s N (if applicable) Phone# C '� I Value of Work For this Permit$ Square/'Linear Footage Of Work. Type of Work: ❑Ad tion ;�tllov� ❑New. ❑ Repair/Replace ❑Demolition Describe Work: P!�l '7-{�OG��' ✓� yl� �l� C�t�J i Ct 40S Submittal Fee$150 e Permit Fee$ CCF$ CO/CC Notary$ raining/Education Fee$ Techiaology Fee$ Scannin g $ Radon DPBR Zoning Bond$ Code Enforcement$ Double Fee$ Structural Review.$ �++' ' ' Total Fee Now Due$ See Reverse side-� Bonding Company's Name(if applicable) Bonding Company's Address City State Zip t 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 tysuance 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 property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first insp which occurs seven ) days after the building permit is issued In he absence of s h posted notice, the inspection will not approved and a rei from fee will be charged. s" Signature t7ftq Signature Owner o Agent f. Contractor °' .. The fore instrument was ackn w ed fore me this The.fa going instrument was acknowledgedfiefore me this day of J 20 ,by day of 20 by wts personally known to me who has roduced who is personally know;'EntiflZon o has produced b S. Z610 As identification and who did take an oath. ° as and who did take NOTARY PUBLIC•• �D1AZ NOTARY PUBLIC: SS gg5 ° b •�' � ��� SA�obe�20,2 � , , OO�M .O��Q�2iinao�a+�e�s 1 ub r - P a E e+ Sign. ?*6 � NN�� Sign: Print: '4� •;jlf..1' Print:• " My Commission Expires: My Commission Expireg: APPLICATION APPROVED BY: Plans Examiner Engineer Zoning (Revised 02108i06)