WS-13-0241f it
AL
WELDING
PERMIT APPLICATI01
Permit Type: BUILDING
JOB ADDRESS: 3 S N I-, 105
City: Miami Shore
Foho/Parcel#. 11- 2-15
Permit No.
Master Permit No
OCT222013
FBc 20
Mi
County: Miami Dade Zip:
- oi3p 0060
Is the Building Historically Designated: Yes
NO 0)c` Flood Zone:
OWNER: Name (Fee Simple Titleholder): E ya and L uSn &&rp o O Phone#,.. S ��Z�
City: Iii 161 U I �h ®rC Ss
Stater Zilr
CONTRACTOR: Company Name: � e- m ct ✓1 i e.) d Phone#:30 S ZS-4 ° 16 bb
Address: 19-115 S W 17-11 TQ1 `-
City: M I A ^ A l State:
Qualifier Name: OaAAA e �1
State Certification or Registration , #:
Contact Phone#: 36^ �K "l " ZZq
DESIGNER: ArchitectUBngineer:
Zip: 3 31
305- ZS4
bl S Certificate of Competency #
it Addr704- �B f 0M q,i B r) P CO°-`
:fn r_ Phone#: 1 ° 360 - 41 lo
Value of Work for this Pewit: $
109 506 ®(>
Square/Linear Footage of Work:
Z 5 3
Type of Work: ®Addition
OAlteration
®New )Repair/Replace
Demolition
Description of Work:
1► :Tm
MA
Color thru. tile:
W A J /J
Submittal Fee $ �� U C Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 306
Bonding Company's Name (if applicable)
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 seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection will not bgapproved Deco a einspection fee will be charged
Signa Si e
Owner or Agent Contractor
The foregoing instrument was acknowledged wledged before me this
day o P , 2011) l
by r�5Ck_ C�r un d day of
who is personally known to me or who has produced I-A wh�
56:5b - 530- _13- A°1�
s u nttfication and who did take an oath.
NOTARY PUBLIC:
Sign: �o �p Q1 $Sfl-
Print: r i c V. INS.
My Commission Ex ' 1 ��
ES: 17, 2617
BondedThm NOWY801 es
APPROVED BY t7ui; Plans Examiner
1") Structural Review
(Revised 3 /12/2012)(Revised 07/1W(Revised 05110 M)(Revised 3115/09)
instrument was acknowledged before me t_his-1
r1f� by 3�-'�
illy known for who has produced �J
on and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
my
Zoning
Clerk
i
0
N- r1l.
MA
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