FW-13-1013Miami Shores Village
Building Department
90050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (30S) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: BUILDING
JOB ADDRESS:, / ORO /" c-_ / 0.5
FBC 20
Permit No.
3-101b
Master Permit No.1 q d
ROOFING
City: Miami Shores County: Miami Dade
o..
Folio/Parcel#:
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple
Address: ® 5
City: Mi ALVL i sko V -'a
S�
State:
M
Tenant/Lessee Name: Phone#.
Email:
i
33 130 .
CONTRACTOR: Company Name: - ✓��(�►°�4�"� t �-�- Phone#: Tl�/D(°J'1)_C1 l ( Q 1
Address: /!;3 -Lt( S(Aj / LL) S�
City: ' A tl I COWA State: _ ��- Zip: 3� e -:4
Qualifier Name: 1 tie(Phone#
State Certification or Registration Certificate of Competency #:
Contact Phone#: _ E : I�A�e_Sc_g_bg_v - 0-9-Nv ` cow.,
DESIGNER: Architect/Engineer: ,0/1-v1 /"yty+y" Phone#: 3® j R4_S-.� )'-(C19
Value of Work for this Permit: $_ .2,/ 00 0'_ Square/Linear Footage of Work: _.S® Z!
Type of Work: OAddition l DAlteration ONew )dRepair/Replace ODemolition
Description of Work: �C % 1,vw-c-f e a PL
I I -L 5 -k .1 % T6 N_
Color thru tile:
Submittal Fee $ Permit Fee
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
eQ__
CCF $ CO/CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City r
State
MortpAe 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." V
Notice to Applicant: As a condition to the issuance of a building permit wit((_ d'value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and cons ib a elien 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 yz:�Z-%-
Signature Signature
Owner or Age Contractor
The forego g instrument was a owled ed,b f1ore meq—qaa__
The foi
day of L,2200, by l/�day of
f
who' onall to or who has pro uced who is
As identification and who did take an oath. l& -
NOTARY PUBLIC:
Sign: IV
Print:
My Commi Sion Expires:
APPROVED BY
V Sign:
SQ�,ZAPSS" Print:
My C
-y%Cr0T Plans Examiner
Structural Review
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
instrument was acknNow ed be o&R�,Aulj
20, by'v� --
11
ef dU
y known t e or who has produced
and who did take an oath.
My COMM Expnes Sep
through National Notary Assn.
42�6�//JZoning
Clerk