RC-13-1205 Miami Shores Village
Building Department -�
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20 /Z)
BUILDING Permit No. -L—
PERMIT APPLICATION Easter Permit No.
NCELL
Permit Type: BUILDING ROOFING
JOB ADDRESS:_(�P%—`13 0�3VIQ sCA,
City: Miami Shores County: Miami Dade Zip:
Folio/ParceW —Z `LC
Is the Building Historically Designated:Yes NO Flood Zone: Do
OWNER:Name(Fee Simple Titleholder): 161 SIT Phone#:77%21) I
Address: � VJIZ (31P %V ,,.
City: and �a Cb- State � °=- 14 Zip: 3' �---
Tenant/Lessee Name: Phone#.
Email:
CONTRACTOR:Company Name: { — � �\kt"V)A Phone#: —1%6 17T
Address:
City: NK i r%.k k State: Zip: 3; �Jz
0
Qualifier Name: Phone#•
State Certification or Registration#: Certificate of Competency#:
Contact Phone# Email Address:
DESIGNER:Architect/Engineer: ,FI a t `1 F 14 j , Phone#:
Value of Work for this Permit:$�/ !' Square/Linear Footage of Work: -/D
Type of Work: DAddition DAlteration DNew DRepair/Replace ODemolition
Description of Work:
Color thru tile:
Submittal Fee$ Permit Fee$� CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
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 p11;.work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit'must-b6'-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) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature l �t+�1 � `tC�
Owner Agent Contractor
The fore in trument as actin ledg d be re c The foregoing instrument was acknowledged before me this
day of ,20 by r� y'of ,20 by ,
w nally own to me or who has produce w is personally known to t c O�• Al identification and who di as identi catio w o eat 1c an oath.
NOTAR UBLIC: - NOTARY PUBLIC:
oil t,\o��
Sign: Sign:
Pant: Print:
My Commiss n Expires: �. My Commission Expires:
+x��'�+x���������������xx��xxs��ss��xe���ss�x��� • :�a :���xx�x�?���_��?�xxx���x
APPROVED BY CJ�Z7plans Examiner ✓ J Zoning
Structural Review Clerk
(Revised 3% a 09 11 0 107)(Revised 06/10/2009)(Revised 3/15/09)
To; W4,zst) � ,rt� eo�•n�
RECEIVED
SEP1.12013
BY: