RC-06-2876A Miami Shores Villagep TOM) E
Building Department NOV 2 9 2006
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ,?
Tel: (305) 795.2204 Fax: (305) 756.8972 B Y. -ky�=�-L-----_----
BUIL 1 �� 'f -�
DING cci,, Permit No. � t
PERMIT APPLICATION 49 Master Permit No.
FBC 2004
Permit Type (circle): Build7in� Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) /_'fi t' ( k � ; Phone #(7 'SQ —
Owner's Address _ �4Z 2 42- 2
^
City � !
lj l State
Tenant/Lessee Name /V
Zip _ 2 2 1. S o
}-P.hone # /V /
Job Address (where the work is being done)
City LZ'&ami ShoresVillage County Miami -Dade Zip :R 2 11 ,.-2
FOLIO / PARCEL #
Is Building Historically Designated YES NO
Contractor's Company Name Phone
Contractor's Adds
City_ ,t _ n s zip—
Phone #
v t Cero ate of Competency No.
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $ Q( y} t t Pfire
Type of Work: ❑Addition ❑Alteration ew
Describe Work:
Phone #
/ Linear Footage Of Work: /6) (3 t�
❑ Repair/Replace
❑ Demolition
Submittal Fee $ Permit Fee $ 1d iAOV
CCF $ U 0, U CO/CC
Notary $ 5(90 Training/Education Fee $ QTechnology Fee $
Scanning $ (0 �90 Radon $ DPBR $ Zoning $
Bond $
Structural Review. $
Code Enforcement $
Double Fee $
Total Fee Now Due $� l
See Reverse side -�
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 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.
1
Signature Awn�R -- Lq-"—
Owner or Agent
The fore oing instrument was
day of��, 20U0 b
who isersonall known to me or who
49-9M _
As identifi
NOTAR
Print:
(Revised 02/08/06)
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of , 20 by
is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
WELLED
Sign:
My Commission Expires:
Plans Examiner
Engineer
Zoning
To: Building Dept, @ 305-756-8972 From: Stephen Petrucci Pg 1/ 1 07/24/14 1:01 pm
AR
401Y 24, 2014,
vill"s Of. Mide"I shorst supdiog Deptirtme"t
0060:14 r= 2rd Ave,
'.Miami Shom,'Fl. 33138:
kioquo6t::tO dahCOU piO"n. RO
# No..: 06-2876
140, NW 102 ST
T NYhOn it in bOncerh,
'. I . Oy
JUL 24 2014
This Wft6e sh9lisiOve: to 10oftnyou that the Shed ralbren-ded.uhdarpeftit Nb,
'IRC -00- 70never inoWled,"For that vown, wemould ,hko to. mpost the -
Permit be: canceled,' -and, dosed..
-ShoUld you .1106-ishylUrther-q h ( so fe6l f t000ntoctm., 6:1MAk"A
cah:bo feached at 9M.471,14''00 x704% or via 6hiait dfggjg�jal
Alan:. ehfid,
Stether M.O.M.Ow-Group
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