CC-10-0999A�
BUILDING
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
PERMIT APPLICATION
FBC 20
Permit Type: BUILDING ROOFING
JUN 0 12010
Permit N:c in-q-qq.
Master Permit No.
Owner's Name (Fee Simple Titleholder) Barry University Phone #
Owner's Address 11300 NE 2nd Ave
City Miami Shores State
Tenant/Lessee Name
Email
Zip 33138
Phone #
Job Address (where the work is being done) Il ' r . '-A flu—", N
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL # 11- 2136- 000 -0050
Is Building Historically Designated YES NO Flood Zone
�°- Y
Contractor's Company Name J !!' M M #its 08mil Phone #
Contractor's Address Y Y Q 7 �O /� 1 �C�
Qualifier Name
State Certificate or Registration No. C i C / SO 7 6 3'Certificate of Competency
Contact Phone E -mail
7
b - Zi 32'' KJ 2'7
Architect/Engineer's Name (if applicable) 'Ccl GA,01 4,h Phone #
Value of Work For this Permit $ V � %® Square /Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration ❑New ❑ Repair/Replace ❑ Demolition
Describe Work: — zf I AJO77
Submittal Fee $ Permit Fee $ /00,�10 CCF $ i' CO /CC $
Notary $ Training/Education Fee $ Technology Fee $ i' laln Scanning $ Radon $ DPBR $ Bond $
<tm�;on date: n1 . $ Total Fee Now Due $ o(, `�,�
See Reverse side ->
Bonding Company's Name (if applicable)
f
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 rs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be appr:� reinspection fee will be charged.
Si tune SignatureL
Owner or Agent Contractor,
The foregoing instrument was acknowledged before me this (9 - The fore ig instrument was acknowledged before me this
day of ! , 20 L4�, by W% LWICILP11 5 PAUCUtEa��tome by
who is pers� lly known to me or or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign: CZ -
Print: i_� , b� ; Notary Public - State of Florida poini-I. Expires A* 16, 2013
My Commission Expires. 6- i b'1 �e Commission # DO 863031
goaded TWW National Notary Assn.
APPROVED BY -/v Plans Examiner
v
Engineer
(Revised 07 /10 /07)(Revised 06/10/2009)
NOTARY PUBLIC: '"" � Yao' eo lodda
My Commission DD613542
Ex ires 1111212010
FSign:
(Print:
Commission Expires: 6' ( / I Z/ Z.b
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Zoning
Clerk checked