BPP-08-1517BUILDING
PERMIT AP
FBC 2004
Permit Type (circ(
Owner's Name (Fee Sin
Owner's Address 7
City MIA GHOKE
Tenant/Lessee Name_
Job Address (where d
City Miami
FOLIO / PARCEL #
Is Building Historical
Contractor's company
Contractor's Address
Citv
Qualifier Name
State Certificate or Rejzi
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores,.Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
e,oT °`.'El, ITItYT 1
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LJ I. ea.mo.�ase� ®eo�e�vo��
1 "�. -
Permit No.
AO ` �r ��
[CATION Master Permit No.
Building Roofing
ple Titleholder) e -W<RLr=S Phone # -78& ` 30 ' ��� r✓°
State FL Zip 33150
Phone #
work is being done) SAMCE, A% A' —
ores Village County iii ' -Dade Zip
Phone #
cate of Competency
Architect/Engineer's Name (if applicable) l Phone #
Value of Wori For thi� Permit $ I � ® Square / Linear Footage Of Work:
Type of Wor4; FIA�dition QAlteration []New ❑ Repair/Replace ❑ Demolition.
Describe Work:
Submittal Fee $ Permit ;Fee $ CCF $ CO /CC
Notary $ i Training/Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $, Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ d U" Total Fee Now Due $
See Reverse side —4
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
zip
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." W Fulne D
Notice to A licant: As a co o a buildin ermit with an estimated value exceedin $2500 the a licant muss
PP f g P g � PP
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 11 Signature
Owner or Agent Contractor
The fo of i went was ac owl"ucre s The foregoing instrument was acknowledged before me this
day of 0 �, by day of .20 _, by ,
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Sign:
Print:
My Commission Expires:
APPLICATION APPROVED BY: M /, gl9! d Sc SPY L4e- t, Plans Examiner
Engineer
Zoning
(Revised 07 /10/07)