RC-08-549 (2)Miami Shores Village MAh 2 8 Luo
Building Department 6 ------- - - -- ----
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING Permit No. PCOZ5~ 5V
PERMIT APPLICATION
FBC 2004
Permit Type (circle): uilding Roofing
Owner's Name (Fee Simple Titleholder)
Owner's Address �lj
Master Permit No.
��I ESU Phone 7S 6 '? lI T
City I I 1AAya14—Zip __331-56Lp In
Tenant/Lessee Nanle
Job Address (where the work is being done)
G
City Miami Shores Village County Miami -Dade Zip 3K
FOLIO / PARCEL #
Is Building Historically Designated YES NO_V"_
Contractor's Company Name
Contractor's Address
City
Qualifier Name
State Certificate or Registration No
Phone# LJ �1 ` �6 r� �J I6
State Zip
Phone #
Certificate of Competency N
Architect/Engineer's Name (if applicable) Phone #.
.W
Value of Work For this Permit $404t)X-,000
Type of Work: QAddition ❑Alteration
Describe Work:
Square / Linear Footage Of Work:
❑New Repair/Replace ❑ Demolition
ie
Submittal Fee $ Permit Fee $ CO/CC
Notary $ Training/Education Fee $
Scanning $ Radon $ DPBR $
Bond $ Code Enforcement $ Double Fee
Structural Review. $
Zoning $
Total Fee Now Due
See Reverse side —4
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 JONERS, ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accura e at &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 inspecti,�n which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection wil�ot approved and a reinspection fe4will be ch*ged.
Owner or Age Contractor
The fore1�piy�n(�g��i��nstrumennt was a owledged before me is Z
day of �•_Vtl�""' _> 20d, b Illi Q APM
whq is personally known to me or who has produced_
-1 As identification and who did take an oath.
NOTARY PUBLIC: tip' 3
Sign
Print:
My C
APPLICATION APPROVED BY:
(Revised 07/10/07)
The foregoing instrument was acknowledged before me this
day of 20 _, by ,
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Plans Examiner
Engineer
Zoning