DS-06-2399IML Miami Shores Village
Building Department ( ��
10050 N.E.2nd Avenue, Miami Shores, Florida 33138,
Tel: (31' U 5 M 6.8972
BUILDING SEP 2 12006 1 Permit No. VoOS DC L'�ft
PERMIT APPLICATION Master Permit No.
FBC 2004 �Yo _.._ i ___________
Permit Type (circle): Building Electrical Plumbing - Mechanical Roofing
Owner's Name (Fee Simple Titleholder) L U 2— Rnr)AmeAPe# — � �/ � — d�
Owner's Address Is
City rn (Al)') C S�,State Zip
Tenant/Lessee Name Phone #
Job Address (where the work is being done ) 1,--'
City Miami Shores Village County _
FOLIO / PARCEL #
Is Building Historically Designated YES
Contractor's Company Name �fy'YJ O (.Q� �j PAL I Phone #
Contractor's Address
City
Qualifier Name
State Certificate or
Architect/Engineer's Name (if applicable)
State
Value of Work For this Permits* S-60
Type of Work:
DAddition
s
DAlteration
Zip
Phone #_
of Competency
Phone #
Square / Linear Footage Of Work: 120 k
DNew EX Repair/Replace D Demolition
m� AN), ct..)G1 0d M ce+n be vac c/
Submittal Fee ,$ Permit Fee $ CCF $ i 0 CO /CC
Notary $_ Training/Education Fee $ • 7 Technology Fee $
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $
Structural Review. $
Double Fee $
Total Fee Now Due $.
See Reverse side —i�
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 REC RING YOUR NOTICE OF
COMMENCEMENT." . F *0t �e�
XIN,�r
Notice to Applicant: As it condition to the issuance of a building permit with aidated value exceeding $2500, the applicant must
promise in good faith that a co '
p g f 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 and a reinspection fee will be charged
Signature 4 ' Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this ZZ The foregoing instrument was acknowledged before me this
day of , 20 , by d z er °Ad Ili? Z , day of . 20 _, by _
who is personally known to me or who has produced WS l Avho is personally known to me or who has produced
R X 2 -.25-6 1 identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
M zN 00 �9
Sign , , �pMM \9 Q0 ®�Z��d,�
Print prm
My Commission Expires:
APPLICATION APPROVED BY:
(Revised 02/08/06)
My Commission Expires:
Examiner
Engineer
Zoning