DEMO-13-2006Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type:
JOB ADDRESS:
WELDING
:SEP 0 4 013
FBC 20itf)
Permit No.
Master Permit No. E
ROOFING
City: Miami Shores County: Miami Dade Zip: 25 04& 3!
Folio/ParceW.
Is the Building Historically Designated: Yes NO ✓ Flood Zone:
OWNER: Name (Fee Simple Titleholder): ' "I e-e.!s e-9 . %`L�tT/ — phone#:_ %7- �9_�0 7
Address: /Y Y dam] 2. t✓a�c s �/�e $/�
city: State:
IM
Tenant/Lessee Name: Phone#:
Email• OA -Ott- rev Z �
7
CONTRACTOR: Company Name: L44_ -R=66 A"e� ° j,_4 mone#:-3d-r_' "71'r 99 !�
Address: 2S S b �'7 . aAL .
City: 7:::7& A-4-t�' 7;thCA State: ° Zip: 3 ®gic/'
e
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
Contact Phone#. Email Address:
DESIGNER: Architect/Engineer. Phone#:
Valve of Work for this Permit: $ ®° o Sgaare/Linear Footage of Work:
Type of Work: DAddition OAlteration ONew ORepair/Replace QE remolition
Color thru'ilk:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ °
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
Owner or Agent
The foregoing instrument was acknowledged before me this
day of --�J—, 201—'5. by rjeAQCkS liy Irt.2f .1
who is personally known tome or who has produced < <
As identification and who" an oath.
NOTARY PUBLIC: ,.�`�,\\\\`
Sign: � CD: — -_
Print: o la
My Commission Expires:
APPROVED BY
�1ZDA
�/0"1111111"
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.
Plans Examiner
Structural Review
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Zoning
Clerk
9600 ne 2 ave - Google Maps
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Goo
- Address is approximate
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