RC-13-2203Miami Shores Village
Budding Department
40050 N.E.2nd A
Tel: (305) 795.24 (530766 33138
INSPECTION'S PHONE NQ 019L. (30P 762.4949
BUILDING
PERMIT APPLICATION
Permit Tw: /' BUILDING
JOH ADDRESS: - q t" J-L-
Permit No.
Ma ter Permit No
SEP 2
o0 0 00
MC 20
ROOFING
City: ��• '
FolicIPanxl9: 1►R18rnl Dad° gyp:
Is the %O tug HistorkaW Dedmte&- Yea N4 �- Zone:
OWMX Name (Fee Simple
Tti
TemnNlelaee Name:
Btnail:
CONTRACTOR: Company Name:
Address: rnone>l;
OF State: a
Qitiifea Name:
State Cati>imlion or Registration N:
COntaCt' mail Ad&=:
��Iti��itiECtIB11� � o
ems:
Yalne of Work for tbis Peru: $
TWof Work: OAddidon 17AWs"Of .. StNm'ell inear.t+'ootage of Work:
ANew
- �'r"n),iif phi•■. �f.,.
ORgWr44plax
NbmkW Fee $ Permit Feet` CCF $
Stilag FeeCO/CC S.
Radon Fee S 'bBPB —sow
Double
Nom` �
$ ntil�nM&n Fee $ Teehno1M Fee $
Double Fee $ Stractww Review f—�
TOTAL FEE NOW DUE S
C:
Bonding Company's Name (if applicable)
0
Bonding Company's Address
City State ZIP
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State
Application is hereby made to obtain a permit to do the work and installations as indicated. I may► 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, FURNAS, 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 COMNIENCEMENT.19
Notice 10 Applicant: As a condition to the issuance of a building permit, with an estimated vahw exceeding $2500, the appl)cant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure win be delivered to the person
whose properly is subject to attachmeru. Also, a cendkd copy of the recorded notice of commencemew must be posted at the job site
for the ,first inspection whi h ccurs seven (7) days ajtter the � g permit is issued. In the absence of such posted notice, the
inspection reinspection fee wi e
Siguuumre
The foregoing inswmcnt was acl(nowledged before pre_ foie_
day of 20 , by
rwho is personally )Mown to rat or who has prced
as identification and W6 did take an opL
NOTARY MULIC:
Structural Review
tRevised 3/12=12)Mte-4 ed 07nOM7XRevkw 06noI1009)(RevW 31,SM
Sign:
Prirst:
My �otinmission Expizrs; ,
Zoning
Clea) r