PT-7-810' Miami Shores Village
�
Building Department
J 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972 k,
BUILDING Permit,
PERMIT APPLICATIOP APR 2 3J,2�007 Master Permit No.
FBC 2004 BY:___ ------
i
Permit Type (circle): uildin Electrical-- 11 Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) _C-3) UN�V-3)6 U o E 77-- Phone # 4"9&
Owner's Address 1022& / tJ • C. • 4+A AV C.
City_ j f/ (� B�1 f . `j ilL State Zip 3pJl 3g
Tenant/Lessee Name (jk Phone #� az�L ._.. — 3 cps acct — Zl S
Job Address (where the work is being done) k0,:3&( 0 • Z • 44- k4e
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL # 1 I — Z Z --3 1 — C> 15 — Q i 20
Is Building Historically Designated
Contractor's Company Name
Contractor's Address
City
Qualifier Name
State Certificate or Registration No._
YES NOS_
UA t-� IE- 0 -
Architect/Engineer's Name (if applicable)
Phone #
Zip
Phone #
of Competency No.
Phone #
Value of Work For this Permit $ Square / Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration X14ew ❑ Repair/Replace ❑ Demolition
Describe Work: ? 107, 'E� d A—
Submittal Fee $ Permit Fee $ LIQ CCF $ CO/CC
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon
Bond $ Code Enforcement $
Structural Review. $
DPBR $
Zoning $
Double Fee $
Total Fee Now Due $ ��►®�
See Reverse side -�
lf'_
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 meetthe 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 gr
estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and ones lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of to o _ ttce of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the hit �1 rmit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be dhc�rge
Signature
Owner or Agen
The foregoing instrument was acknowledged before me this
day of . nL 20v T , by �� ffi� ,i/`?
who is personally known to me or who has produced , l 5'
As identification and who did take an oath.
NOTARY PUBLIC:
Sign: /
Print:
My Commission Expires:
APPLICATION APPROVED BY:
(Revised 02/08/06)
Signature.
Contractor
The foregoing instrument was acknowledged before me this
day of .20 by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Print:
My Commission Expires:
Plans Examiner
Engineer
Zoning