SGN-06-1673 {
Miami Shores Village RECKWED
Building Department JuN 2 1 zoos
10050 N.E.2nd Avenue,Miami Shores;Florida 33138 1 R
Tel:(305)795.2204 Fax:(305)756,8972
BUILDING Permit No. °0
PERMIT APPLICATION Master Permit No.
FBC 2004
Permit Type(circle): uildiag Electrical Plumbing Mechanical Roofing
Owner's Name(Fee Simpl Titleholder) GITIPIA✓IJ' Phone# 30S"7J-4f 40111(' /
Owner's Address
City / »'! State rip
Tenant/Lessee Name /ZZi9 / p
Job Address(where the work is being done) e9U0 d/tf
City Miami S County MLami Dade Zip
FOLIO/PARCEL#
Is Building Historically D ignated YES NO
q
Contractor's Company N � �c C
e � ,t� (10. Phone# 76 3 eV
Contractor's Address of ,S IVAI 6 Wi
City State !
zip 333 /
Qualifier Name a.l D S� H L,��GG�9a2¢I one# Ste/.76,?VW0
State Certificate or Registrat on No. &'.S0002 3S 7 Certificate o
W
Architect/Engineer's Name(if applicable) %nJ G 4 ' Phone# w-',,S-6,a
Value of Work For this its 9aoa Square I Linear.Footage Of Work:
1-7 Imo« ",U
Type of Work: ❑Additi n ElAlteration []New Repair/Replace ElDemolition
Describe Work:
v L� a5/lief /ryv� N G�� .e�E 144-4W .
x
Submittal Fee$ Permit Fee$ CCF$ CO/CC
Notary$ Training/Education Fee$ Technology Fee$
Scanning$ Radon$ DPBRI$ Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due$
See Reverse side-�
a,
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 '
� g 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 properly is subject to attachment. Also, a certyled 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
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of .20 ,by day of .20_,by
who is personally!mown to me or:who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
My Commission Expires: My Commission Expires:
APPLICATION APPROVED BY: Plans Examiner
Engineer
Zoning
(Revised 0210W