EL-10-1181v Tv"vA ; o 4N"ARAc kA-V",.•7114FAG lA1GA,V14ql�1 I`i�
Owner's Address % G5 i -x ray A �b VAC
CitY SU�a wi. 5AO CeS State
Tenant/Lessee Name
Email
Job Address where the
work is bein�done� �
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yr�[
CityMiami Shores Villa ee County mintimi_naAw 7;
Bonding Company's Name (if applicable)"�I
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) /y -
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a`permt 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 beL secured -for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC.....
OWNEW'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' Wroved and e -inspection fee will be charged.
Signature Signature
_eC��
r or Agent Contractor
The foregoing instrument was acknowledged before me this OR The foregoing instrument was acknowledged before me this •Z I
day of u_L , 20�d , by CNl�t S � � aN day of ZAAC , 20 1_0, by heti tLeg u Aow�so
who is personally known tome or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Print:
My Commission
Sign: � ' i'�'
Print: _ 1
My Commissio:
EXPIRES: OCT 16, 2012
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AU
APPROVED BY Plans Plans Examiner Zoning
Engineer
(Revised 07/10/07)(Revised 06/10/2009)