DS-08-0787rOW-t* /i4-pv AIiami Shores Vill 71-
Building Department APR 2 9 730
10050 N.E.2nd Avenue, Miami Shores,. Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972 B Y. _ ........
r 1, A V N
BUILDING Pemit No. O
PERMIT APPLICATION Master Permit No
'"C 2064 CANCELLED
Permit Type (circle Building Roormg
Owner's Name (Fee Simple Titleholder). JOSS-Ft-A- C • �t%_t_L Phone 305 Z9
Owner's Address 'Zv7 3 tA VJ '17- -5 —1
City_ tA t A4A t � zip
itt—*M5 State
Tenant/Lessee Name —,
Job Address (where the work is being done) SArkks
City Miami Shores Village County
FOLIO / PARCEL #
Is Building Historicatly'Designated M
NO _X'
—Phone # I
Contractor's Company Name 1.1m, OIX Phone #
Contractorl'! Address
City State—Zip-
Qualifier Name Phone
State Certificate or Registration No. Certificate of Competej�cy No.
ArchitectiTingineer's Name (if applicable)
Value of Work For this, Permit $
Type of Work: ElAddition ElAlteration
Describe Work: CONCMT9,
Phone #
III
—
Square Linear Footagebf Work: 100 s q. V_T.
ONew Ripair/Replace ❑ Demolition
acv_ KI
SAND
Submittat Fee $ Permit Fee CCF CO/Cc
Notary Training/Education Fee $ TechnologyFee$ 15 4,
_b!m
Scanning Radon $ DPBR Zoning
Bond Code Enforcement $ Double Fee $
Structural Review. Total Fee NowDue
See Reverse side
iii
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
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 IMPROVE fl J%:PNERT% IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LE lTTEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT." �w
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 a reinspection fee will be charged
'f n i e
Owner or Agent Contractor
The forqgoiAg instrument was a owl ¢d re Aae this
day of , 20�, by 0A
b►iJ
/
.� identification and who did
The foregoing instrument was
Sign:
acknowledged before me this
day of , 20 _, by ,
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print- V 1.9mg 4V Print
My Commission Expires: My Commission Expires:
APPLICATION APPROVED BY:
(Revised (Y7110107)
Plans Examiner
Engineer
Zoning