MC-06-349 Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
BUILDING ISE EIVE® Permit No. MC0(c:�— 34-Cl
PERMIT APPLICATION F Z966Mater Permit No.iC-0 — ( I C
FBC 2001
Permit Type(circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder) j ivy-)rmLI f-16.4 Phone# CJb6� 7 1poZ — 61a OR-
Owner's Address `T y I Aj.e– C?/ o*J- r r ,
City(4001 &AVcgs State 1 zip 33 /3
Tenant/Ussee Name Phone#
Job Address(where the work is being done) gql 41, 91 sJ– -1-e rr .
City Miami Shores Village County Miami-Dade zip X33 ) 3
Is Building Historically Designated YES NO
Contractor's Company Name Phone# e30CF! y 9(a i'q,31
Contractor's Address
City lk4laff9l State
Qualifier
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name(if applicable) _ 1( �., �Q m Phone#
$Value of Work For this Permit a .V� Square Footage Of Work:
Type of Work: ❑Addition []Alteration ❑New ❑ Repair/Replace
El Demolition
Describe Work:
C
Submittal Fee$ Permit Fee$ CCF$ . 80 CO/CC
Notary$ Training/Education Fee$ t7
' . 6C7 Technology Fee$ 2. 1:7.
Scanning$ I:s 1�� ' Radon$ Zoning Bond$
Code Enforcement$ Structural Plan Review.$
Total Fee Now Due$ I �3
(Continued on opposite side)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable) x
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: 1 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 co truction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the rec otice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the buildin is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be char
Signature afore
Owner or Agent Co ctor
The foregoing instrument was acknowledged before me this The fore g instrument was acknowledged before me this
day of ,20__,by day of 20 n by ,
who is personally known to me or who has produced who is p e or who has produced
As identification and who did take an oath. as 'dentification and who did take an oath.
NOTARY PUBLIC: NOTARYP LI
Sign:
n:
Sig
Print: Print: fwutfN
4 i
My Commission Expires: My Commission Expires:
************************************************** ************** ****** *********************************
ZAPPLICATION APPROVED BY: f I Plans Examiner
Engineer
Zoning
chc 05/13/03