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PL-06-348 Miami Shores Village Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.22 56.8972 �rZ11V BUILDING 06 Permit No. FEB 0 2 - o PERMIT APPLICATION aster Permit No. FBC 2001 -•r Permit Type(circle): Building Electrical Plumbin Mechanical Roofing Owner's Name(Fee Simple Titleholder) I M M u . _ Phone# U(2s) Owner's Address (:: q City MlQiy)) &3h es State Zip Tenant/Lessee Name Phone# Job Address(where the work is being done) 941 P L q/ -5-A 4e-rr. City Miami Shores Village County Miami-Dade Zip 3343e Is Building Historically Designated YES NO Contractor's Company Name J V I 11-6Phone# _3o r- 261 �- Contractor's Address % 2 V 5 L cJ 7 C A(- City I/V1 I ��' State 'L- Zip 33 l JT Qualifier State Certificate or Registration No. Foo 39)-o Certi cate of Competency No. C v O c)J !M 6 Architect/Engineer's Name(if applicable) OVA Phone#- $Value of Work For this Permity Square Footage Of Work: �� q Type of Work: []Addition ❑Alteration ❑New ❑ Repair/Replace El Demolition Describe Work: Submittal Fee$ Permit Fee$ � `— D� CF$ 2 , CO/CC. Notary$ Training/Education Fee$ ©.80 Technology Fee$ -4- Scanning$ 3.C Radon$ Zoning Bond$ Code Enforcement$ Structural Plan Review.$ Total Fee Now Due$ 1 -7 0• ZZO (Continued on opposite side) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) a 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 IMPROVEMENT_S 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 conston 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 Agentontractor The foregoing instrument was acknowledged before me this The foregoing instrument was tvowledged before me this 20 day of ,20_,by day,gf 2 q who is personally known to me or who has produced i who is person ly a or who has produced As identification and who did take an oath. emification and who did take an oath. NOTARY PUBLIC: NOTARY P _ Sign: i Print: V P9 RENE 1UMA ' My Commission Expires: ar= Commission#DD194890 h bt� dV'I�Iftl�} l �''n. ************************************* ** * *** ********************************************************** APPLICATION APPROVED BY: " d — 61"'Plans Examiner i Engineer Zoning chc 05/13/03