EL-06-1738 Miami Shores Village' ,Ap Iow
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax: (305)756.8972
BUILDINGPermit No. -� t... b v °
PERMIT APPLICATION �� 1 O 2006 Master Permit N�.
FBC 2001
Permit Type(circle): Building pric - �WfMbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder)— iX ow_Arlo Phone# �.Y421'0., ,7.1-
Owner's Address 9,30 Z /Mal/' Uf
City IW/W1!j �,M-11940o0 State rG Zip c3�/.S�PJ
Tenant/Lessee Name --- Phone# --�
Job Address(where the work is being done) !",OZ /lei l•!/• Z
City Miami Shores Village County Miami-Dade Zip
Is Building Historically Designated YES NO ✓
Contractor's Company Name _,phone# �a' ���a•�7
Contractor's Address
City State Zip
QualifierT.�h�. ,�92� 3L�— V"— 1727
W /
j/�
State Certificate or Registration No. Certificate of Competency No. OAOO
Architect/Engineer's Name(if applicable) Phone#
Clio
$Value of Work For this Permit Se> ao age Of Work:
LLn
Type of Work: UpIldition ❑Alteration New
[��tepair/Replace El Demolition
Describe Work: .� G•
Submittal Fee$ _0 Permit Fee$__,Z��,i i eD6 CCF$ CO/CC
Notary$ Training/Education Fee$ Technology Fee$
Scanning$ Radon$. Zoning Bond$
Code Enforcement$ Structural Plan Review. $
Total Fee Now Due$
Continued on osite side
( PP )
i
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.
Signature Signature
Owner or Agent. Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this J
day of ,20_,by day ofd!/ % 20 496�,by ,
who is personally known to me or who has produced o is personally,known t Dr'ivho has produced
As identification and who did take an oath. �� as ideation and who did take an oath.
NOTARY PUBLIC: - NOT UBLIC:
Sign: 9
Print: t: r'b `Ul.SVE CO s
COMMISt,2�
My Commission Expires: My Co _ i ties:dance
APPLICATION APPROVED BY / Gs Plans Examiner
Engineer
Zoning
Cho 05/13!03