EL-06-885Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida. 33138
�V� el: (305) 795.2204 Fax: (305) 756.8972
MCF07m]
BUILDING 0 Permit No.
PERMIT APPLICATIO;BYT
AP 0 2006 Master Permit No.
FBC 2004 Permit Type (circle): Buildingtri al Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder)d �n 9 Ywiez- Phone #
Owner's Address ,� /tea 1� 5
City A �M,- ,. kYz_1State Zip 33" 3
Tenant/Lessee Name Phone #
Job Address (where the work is being done) s.� . E `� fST,.
City Miami Shores Village County . Miami -Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES NO.
Contractor's Company Name 1 /76. Phone # (3,ar "' 'Fl® 12 -
Contractor's Address
City
Qualifier Name
State Certificate or Registration
Architect/Engineer's Name (if applicable)
t�
Value of Work For this Permit $ 15730
.S
P,
. I—Zip C
_Phone # Z 3 12 -
of
Zof CompetencyNo';L�4�0?O
Phone #
Square / Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration 5(New ElRepair/Replace El Demolition
Describe Work: s 4l /�9c
-%- d1",& '541 _OAI V 9e.444�
J -
Submittal Fee $\\I Permit Fee $ .5 dei d&Q' CCF $ CO/CC
Notary $ I Training/Education Fee $.
Scanning $ Radon $
Bond $ Code Enforcement $
Structural Review. $
Technology Fee $
DPBR $ Zoning $
Double Fee $
Total Fee Now Due $
See Reverse side —>
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.
Signature
44 -
Owner or Agent
The foregoing !rinstrument was acknowledged before me this
day of 20 d _6 by Zj,o S AfZA44,47,
who is --e..,,p rsonally known to me or who has produced
As identification and who did take an oath.
r= `
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of 20 & by A&�� 44,9
who is personally known to me or who has produced
NOTARY PUBLIC: �� -,, Matra E. Fattier
YPUB��; Commission#DD173118
'' cP Expires: Dec 22. 2006
-1
Si do` Bonded Tbru
' e1.1mitic Bonding. Inc.
Print: 44177k� to _ %/
My Commission Expires:
APPLICATION APPROVED
(Revised 02/08/06)
as identification and who did take an oath.
NOTARY PUBLIC: Maira E. Faltier
Commission #DD173118
=* Expires: Dec 22.2006
Bonded Thor
Sign: Atlantic Bonding Co.. Inc.
Print: �%� tLy l -e
My Commission Expires:
Plans Examiner
Engineer
Zoning