FW-13-2500Miami Shores Village
NOV
13 13 g .I Buildin Department
t I P � _-_�
10050 NE -2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (30S) 7624949
FBC 20
BUILDING Permit No.
PERMIT APPLICATION Master Permit No. -F W 13
Permit Type: BUILDING ROOFING
JOB ADDRESS: 2® �G y? 6-7
City: _ Miami Shores County: Miami Dade Tap: ? 3 13
Folio/Parcel#:
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): , w�.P A -6Z 1c phone#:YA- (o 2 27 Mff Y
City: / "C' u.L i e s h.o 'es State: iz . Zip: —'T 2; /IA
Tenant/Lessee Name: Phone#
Email:
CONTRACTOR: Company
Address: C --
City:
-7:11
Qualifier Name: Monet K ' 27Z*46F �
State Certification or Registration #: C GC. 1 SOt f e7 Certificate of Competency #:
�,a,-,. _ _ Contact Phone#: Email Address:
DESIGNER: ArchitecV&gineer. Phone#:
Value of Work for this Permit: $ 450 S
` quare/Linear Footage of Work. 5S) / �-+
Type of Work: OAddition
Desariptlon of Work: 2j
Color thru ills:
ONew ORepairftlace ODemolition
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Senning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Eduedon Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
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
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 occurs seven (7) days after the building permit is issue the absence of such posted notice, the
inspection will not be approved and a reinspection fee wi de dwped.
Ort• '
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Signature h /y. 1 %A, d aw - IBM?
i 9 O A A S1g�latDie
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Owner or Agent _ ' NOTARY P BLIC _ °A = ' NOTARY PUBLIC I
The foregoing mstrume�nt�'as acknowledged before riteQ �# : ° Th4oregoing instrument was ackao ledged befI nr� Ah A g
da of 20x3 by A �'••.�E160045.•�® yof 20i.3 by ( EE160045,.0 \`
'� e erg ¢• \Q;\..
o is personally kn to me or who has produced''''�,�� 0 F� F� " \\�'\` o�Pers�nal�rb:noZ�tqor who has produced ''
As identification and who did take an oath, as identification and who did take an oath.
NOTARY PUBLIC: s j . , `J- .
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Sign:
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My Commission Expires: My Commission Expires:
APPROVED BY
Plans Examiner (� Z //� Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/20W)(Revised 3/15/09)
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