DS-06-1580-Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fag: (305) 756.8972
PERIVHT
FBC 2001
Permit Type (
APPLICATION � JON 0 9 200
Owner's Name (Fee
City
Permit No. 03C(O— 1
Permit No.61OG - EeS
Tenant/Lessee Name Phone #
Job Address (where the work is being
City Miami Shores Villaee County Miami -Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's Address
Cityjn l �� 1 y--, .
State Certificate or Registration
Architect/Engineer's Name (if applicable)
State
Zip
Certificate of Competency No.
—Phone, #
$ Value of Work For this Permit tf2 Square Footage Of Work: Xq
Type of Work: []Addition > []Alteration _ (� ew
Describe Work: I "� i r4f 'i l tl )P /e v
,e4, ❑ Demolition
Submittal Fee $ Permit Fee $ 10 i CCF $ 1 Zo CO/CC.
Notary $ Training/Education Fee $ Q. 94c) Technology Fee $
Scanning $ . CQ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
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 bp -'performed to;, meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for EL ECTRIGA6 WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS`snd A1R 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 o"hing.
"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 thatq,copy of the notice of commencement and construction lien law brochure ' e delivered to the person
whose property is subject to"ay c Is�gcertified copy of the recorded notice of commence ent must a posted at the job site
for the first inspection occurs seven (7) day after the building permit ' ass d t absence of such posted notice, the
inspection will not beroved and a reimpectio a will be charged
SignSigna
Owner or AgentV---1>6QCtor
The for"e oing instrument was ac a before_ me this � The fo gd`mg instrument was acknowledged before me this
day o 200 6 by 94 P day of 20& by
who is perso y known to me or who has educed who is personall own to me or who has produced
As identification and who did take an oaths as identification and who did take an oath.
NOTARY (�Pi
NOTARY P LI
Sign: Sign:
Wit:Print:
* -§M Latimer
My Commission ExpireSlTg my Omission DD0167213 My Commission Expires:, s M Lamner
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, J �OF Expires November 24, 2006
APPLICATION APPROVED BY: l PIans Examiner
Engineer
Zoning