DS-11-1211BUILDING
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
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Permit No.D5 I I --� Zap_
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Typ : BUILDING ROOFING
OWNER: Name (Fee Simple Titleholder): A WCZ-:S CUC?—r?T Phone #:7L7—S9 d 1 — �p 1 07 q 1
Address- 1.1900 DE V0 0 D?-.
City: C CA(t.'CAIATCIL J�,eACL -1 State: Zip: 73 76 7
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: PAP_Le-1 Jq L-0 —t 9-43r, wiE- Z Auz —
City:
Folio/Parcel #:
Is the Building Historically Designated: Yes
Miami Dade Zip: 33 13 2
Flood Zone:
CONTRACTOR: Company Name: &� UP�� Phone #:
Address: 4_4;:Vn f j
City: z/_ / State: Zip:
Qualifier Name: ^o>c e Y _ ! S h Phone #: -90 5 �- b
State Certification or Registration #: C (- -C_ 15:3 2L— 1 G .?� Certificate of Competency #:
Contact Phone #: Email s:
DESIGNER: Architect/Engineer: C c_ PU ®t ®f:R_c- P • Phone #: 7&6-387-A615.
Value of Work for this Permit: $ inear Footage of Work: d
Type of Work: ❑Addition DAlteration ONe 2<epair/Replace ODemolition
Description of GS V F� e r�0�b� R- C _�� l P
pko Work: & r 11J
P42, R— (r— 10 L-o oy ® q 6 36 VIE 2 A\j
Submittal Fee $ D . CQ^ Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Structural Review $
Technology Fee $
TOTAL FEE NOW DUE $
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 RESU YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PRO I YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LE R AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEM&7 ."
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 anOa onstt uction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recgided 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 b approved and a reinspection fee will be cht�t'ge' ,
Signature 1� /`- �"�'`�c�''./ �v —LrsW Slg� ---� v✓�®"' �..°�
identification and who did take an oath.;
APPROVED BY Plans Examiner
(Revised 07 /10 /07)(Revised 06 /10 /2009XRevised 3/15/09)
Structural Review
Zoning
Clerk