EL-06-783Z: CC
BUILDING
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fag: (305) 756.8972
PERMIT APPLICATION
FBC 2004
Permit Type (circle): Building
Owner's Name (Fee Simple Titleholder)
Owner's Address 6�,53 /Va_
R
1406
Plumbing
req 450(,
Permit No.ELCG
Permit No.
_133
Mechanical Roofing
City Lkll# d'70', ShAE Zip
Tenant/Lessee Name Phone #--
Job Address (where the work, is being done) ��� A 96
City Miami Shores Villa
se County . Miami -Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES NO,
Contractor's Company Name
Contractor's Address `f4Z l 69d-ib/9e
City State
Qualifier Name
State Certificate or Registration No..
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
Type of Work:
Describe Work:
;r G 2 1�7 G, Phone # 3 ®Y- 2- 3 9- Q 4 12—
Total
Z
\�
zip__33
Phone #
Certificate of Competency No.
Phone #
Square/ L' o e Of Work:
Submittal Fee $ Permit Fee $ z g� o r� ®' CCF $ Q CO/CC
Notary" Training/Education Fee $ o % Technology Fee $ o
Scanning $ S- 00 Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $
Total Fee Now Due $ j,--_-37
A 2.7 PAIDee Reverse side -�
c ��
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip ,
Mortgage Lender's Name (if applicable) v`
Mortgage Lender's Address
City State 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 bepfp-proved and a�inspection fee will be charged.
Owner or Age
The foregoing ins ent was ackno ed before methis Z
day of , 20 0l0 by L ui S 1qe r-A4✓%dtZ- ,
who is personally kaowato me or who has produced
Signature
fa _ Contractor
Tl* foreg ' g ins ent was acknowledged before me this Z_
day -of I �it � , 20 0 by �Dhde4o d�a5 ,
who is personally known to me or who has produced
As identification and who did take an oath.
Maira E. Fakier
NOTARY PUBLIC: ��►�`! "�
Commission #DD173118
Expires: Dec 22.2006
;vo"ofi°� Bonded Thru
Sign: Atlantic Bonding Co.. Inc.
Print: / v 1!/L GZ _mac' , Qtt
My Commission Expires: N0 - 27, 2:00f,
as identification and who did take an oath.
Maim E. Fakier
NOTARY PUBLIC:
Commission #DD173118
Expires: Dec 22 2006
.s Bonded Thr"
Atlantic Bonding Co., Inc.
Sign: !�
Print: A&a__ �e PEC
My Commission Expires: Dt c - Z- Z Z`CO
APPLICATION APPROVED BY:
(Revised 02/08/06)
Plans Examiner
Engineer
. - Zoning