RC-09-28 Miami Shores Village ,,, AkW
!-- Building Department
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�" � c� 10050 N.E.2nd Avenue,Miami Shores,.Florida 33138
&,4&9A• o Tel:(305)795.2204 Fax.(305)75618972
BUILDING D Permit No. 7�
PERMIT APPLICATIO 200 Master Permit No,
FBC 2004 --- -,. _ A,%; De -
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Permit Type(circle: Building .Roofing Colt 4 51r" �2 6 Go 2
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-- - -- Owner's Name(Fee Si�ple Titleholder),
Owner's Address 5
Ci 1' , " _ State �/�
Zip ,°7 3
Tenant/Lessee Name Phone#
Job Address(where the;work is being done)
City Miami Stores Village^ County Miami-Dade Zip
FOLIO/PARCEL# Aft
Is Building Historically Designated, YE5
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Contractor's Company ame Phone#
Contractors Address
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City State Zip
Qualifier Name Ane#
State Certificate or Registration No. Certificate" o" cy No.
Architect/Engineer's Nalme(if applicable) Phone#
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Value of Work For Permit$ -5 i'eel 0 Square/Linear Footage Of Work: q
r
f°="7
of Work: . A dition ❑Alteration ❑New,i ❑ Repair/Replace (.Demolition
Desin'.be Work: 1 � 0� r=
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Aa 19 �i,Y
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 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 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 inspection which occurs seven (7)-i4ys after the building permit is issued In the absence of such posted notice, the
inspection will not be approved and a remspe Lion oe il, a charged.
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Signat -Signatpre
Owner or Agent /f .Contractor
The foregoing instrument was acknowledged before me this The foregoing nstru�nent was acknowledged before me this
day of �JOy- ,200--b,by - -, day of ,20—,by ,
who is personally known me r who has produced ;. produced—
As
� f w�o�is �na k ewn to me or who has
identification and who did take an oath. _ ` — as i0en4cation and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: e Sign_
Print: l�/, f f� �+ It> a Print: _I
aFa�� EXPIRES:ocL3,2009
My commission Expires:�y,3,�� M SM153 Florida wow,�emo� My Commission Expires:
APPLICATION APPROVED BY: Zf 126 ' Plans Examiner
Engineer
Zoning
(Revised 07/10/07)