EL-06-347 Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores Florida 33138
Tel:( !0 7 6.8972
KrA
BUILDING F 2406 Permit NoJE � — 3 4.1
PERMIT APPLICATION aster Permit No.
FBC 2001
Permit Type (circle): Building lectrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder) 1���U EQ�s Phone# C` -7{D �p( L&>t-
Owner's Address �`i ]� , q��.1 p{( .
City I Ct iM I ! Irh eS State IF( Zip 33 1_3 9
Tenant/Lessee Name Phone#
Job Address(where the work is being done) ��t - 910 4jy/,
City Miami Shores Village County Miami-Dade Zip 3g
Is Building Historically Designated YES NO
Contractor's Company Name C_ Phone#
Contractor's Address D3 aQ a0 A_e_�'K.
City Vit to✓Y1 1 State E - Zip 3:3 1'7 S'
Qualifier 15/ayl o_6c*-) r- �Ir'eZ
State Certificate or Registration No. ER two 073' Cez to of Competency No. 066 0 g -7V
Architect/Engineer's Name(if applicable) OLPhone
$Value of Work For Ais Vermit 5 Square e Of Work: q ,3
O
Type of Work: ❑Addition ❑Alteration /New ❑ Repair/Replace ❑Demolition
Describe Work:4= l- - f�C_4—T �O Y K r r-��uw Q�lcl I -I--r c ►--�
Submittal Fee$ ri> Permit Fee$ CCF$ 3 (00 CO/CC
Notary$ 22 Training/Education Fee$ -Z� Technology Fee$ 4. .$C) .
V
Scanning$ -0 Radon$ Zoning Bond$
Code Enforcement$ Structural Plan Review. $
Total Fee Now Due$ Z0
(Continued on opposite side)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
r I ,
Mortgage Lender's Name(if applicable)
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 be approved and a reinspection fee will be charged.
Signature Signature
Owner or Agentctot�_a.C,+aS
ig1
The foregoing instrument was acknowledged before me this The foregoin ' ore me this 10
o�
day of ,20_,by day of 1hrn
uOWAVAUM S
who is personally known to me or who has produced who is per ly knome or who has produced
As identification and who did take an oath. , _ide who did take an oath.
4t,111- ,, � 's�i as
NOTARY PUBLIC: NOTARY P -� D117M4
Sign: Sign: 21
+u
Print: Print: L.
My Commission Expires: My Commission Expires:
APPLICATION APPROVED BY: ' Plans Examiner
Engineer
Zoning
Chc 05/13/03