WS-7-111 Miami Shores Village
' � JAN 2 � �
Building Department 200,
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY.-
Tel:(305)7 5.2204 Fax:(305)756.8972 =-.......
BUILDING 1 - Permit No. • S l 1
PERMIT APPLICATION Ad. Master Permit No.
FBC 2004
Permit Type (circle): uilding Electrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple Tit eholder) � L�i I I I CLMS Phone#
Owner's Address
CiGt.Y�r"LIOf�s State �L Zip 33
Tenant/Lessee Name Phone#
Job Address(where the work is being done) � � �W Z 5-f
City Miami Shores Village County Miami-Dade Zip
FOLIO/PARCEL# I I — O 10
Is Building Historically Designated YES NO
Contractor's Company Name 0 aj jl � bnhone#__-] _ L-]^" a ScQ: _
Contractor's Address 0 C;Lj iv!_
City / State FL
Qualifier Name
State Certificate or Registration No. Certificate of Co19
cy No.
Architect/Engineer's Name(if applicable) Ph 1�&r_
Value of Work For this Permit$ i ,060' 0o Square/Linear Footage Of Work:
T
Type of Work: ❑Addition n ❑Alteration ❑New Repair/Replace ElDemolition
Describe Work:y� �n IAA) U tnd w-r '
Submittal Fee$ Permit Fee$ _/ CCF$ •U CO/CC
Notary$ Training/Education Fee$ 0 40 Technology Fee$
Scanning$ Radon$ DPBR$ Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due$
See Reverse side—�
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
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.
Signatureignature
Owner or Agent �� Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of ,20_,by day of .20 by
who is personally known to me or who has produced who is personally known to me or who has produced
As identification d who did take anoa . as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
My Commission Expires: My Commission Expires:
APPLICATION APPROVED BY: L /' Plans Examiner
Engineer
Zoning
(Revised 02/08/06)
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
q 10050 N.E.2/ndd Avenue•MiaamiShores,Florida 33138.305-7795-2204
Date /'/, Q Job Address& U /CLW �O y 3)` Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee/Tenet / S Master Permit#
Owner's Address 77 Phone
Contracting Co. A,C.t (�c��.Address A& ME)
Qualifier Phone
State# 6A.� 44AwMunicipal# Competency# Ins.Co.
IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY,
THERE WILL BE NO INSPECTION. RE-INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE
BEFORE CALLING FOR ANOTHER INSPECTION.
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING
WORK DESCRIPTION:
Square Ft. Estimated Cost(value)
WARNING TO OWNER:YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN
YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY(IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR ANY ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above,and on the attached addendum(if applicable).I certify that
all work will be performed to meet the standards of all laws regulating construction in this jurisdiction.I understand that separate permits are required
for all disciplines.
OWNERS AFFIDAVIT: I certify that all the foregoing information it all work will be done in compliance with all applicable laws
regulating construction and zoning.Furthermore,I authorize the above n t d the work stated.
Ila//0& i /e/0 7
Signature of owner and/or Condo President Date Signature of Contractor or Owner uilder Date
QAY L D11NN
MY CO►d+1113S1ON#DD 56
EXPI �AS I, � / /F o
caner anDate N for or Owner Builder Date
M ommission Expires My Co ion Expires
FEES:PERMIT RADON C.C.F NOTARY BOND
APPROVED: TOTAL DUE
Zoning Building Electrical
Mechanical Plumbing Structural Engineer