MC-11-0153Miami bores' Village
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10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Teh (305) 795.2204 FaX. (305) 7561.8972
BUILI)''ING Permit Igo.
PERMIT APPLICATION luster Permit N
FBC 20 I!
Permit Type: NWCHANICA C
Owner's Narne (Fee Simple Titleholder) Phone #
(5wner's Address 'Ayr-
/b4
City 9l&4A_- State 84— zip. 33( '?g
Tenant/I essee,, Name.lk" -- Phone #
Email
Job Address (where the work is being done)
City __ Miami ghores Village County
FOLIO / PARCEL # ' E)rJ l
Is Building Iiistoricall l Designated YES NI
co CQt6piny Name
Contractor's Address
City disco_
Flood Zone
Phone #
Qualifier Nanle C F rr���� Z-- Phone #
State Certificate. or Reg stration , 40< ri : � � . Certificate of Competency. No.
i
Contact Phone E -mail j
Architect/Engineer's Name applicable) G&-4-P 6Ad L_ Phone #
h
Value of Work Foe -this Feria $ °'� • Square /Linear Footage Of Works .
Tape of Work-
Desc>Nnh6 W� rk"
Repair/Replace
Submittal Fee $ Permit Feel,,$ " CCF $ CO /CC • •
Notary $ Training/Education Fee $_ Technology Fee $
Sca nning $. Radon $ DPB R
$ Zoning $
Bogd $ Code Enforpement $ Double Fee'$
Structural Review. $ Total Fee Now Due $
See. Reverse, side —>
Bonding Company's Name (if applicable)
Bonding Company's Address
C C i Ly State
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 1* 1 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, T HERS, ETC ....
OWNER'S AFFIDAVIT: I certify that all the foregoing i 0 is 4ccurateand 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 T . 0 OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING. YOUR NOTICE OF
CONR"NCEMENT:'
Notice to Applicant. As a condition to Me issuance of a building permit with an estimated value exceeding $1500, the. applicant must
p
ptomise'in good' faith that a COPY of the notice of commencement- and construction lien law brochure will be delivered to, the person
whose property is subject to attachment. Also, a . copy, of the recorded notice of commencement must be posted at• thg job site
for the first inspection which. occurs seven (7) days after the -building permit- is issued. In the absence of such posted noticei.:the
inspection will not be approved and a reinspection fee will be charged.
Signature. Signature
Owner or Agent, C6ntractor
L
The foregoing instrument was acknowledged before me this The j�e t knowledged before me this
day of -20 by
day kip C by
who is personally knom9lo, me or who has produced who is personally known to . me or'who has produced��.
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
NOTARY UC= OF FWRWA
Sign: Sign: L
Print: Print: h. e$; 10,2012
r
ism
My Commission Expires: MY Commission Expires:
APPLICATION APPROVED BY Plans Examiner
(Revised 07/1-0107)
Zoning