FW-06-10 Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
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BUILDING Permit No. �! - -06-- I D
PERMIT APP IL CATIoN aster Permit No.
FBC2001 -R - .Permit Type(circle): Building Electricalumbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder) 104A U6A 2E = Phone# (;-7,0S)
11
Owner's Address to
City �� 0 5 tyo-te S State f=/® 6V G Zip -3sl3g
Tenant/Lessee Name Phone#
Job Address(where the work is being done) >� �� /03 &,1'
City Miami Shores Village County Miami-Dade Zip Z3,313 8
Is Building Historically Designated YES NO
Contractor's Company Name 4—fi=)M *- 41E-R_ _ Phone#
Contractor's Address
City State Zip
Qualifier
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name(if applicable) �:. Phone#
$Value of Work For this Permit AZ- ��• �' ,; are Footage Of Work: $ .r
Type of Work: ElAddition ❑Alteration E]New ❑ R air/R lace
ep ep ❑Demolition
Describe Work:
Submittal Fee$ Permit Fee$ CCF$ d CO/CC.
Notary$J--(30 Training/Education Fee$ C)L 0 Technology Fee$ ?J• Zjo
Scanning$ & 00 Radon$ Zoning Bond$
Code Enforcement$ Structural Plan Review.$
Total Fee Now Due$
Continued on ite side
( PPS )
Bonding Company's Name(if applicable)
J
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 en (7) days after the building permit is issued In the absence of such posted notice, the
inspection will not be approve einspection fee will be charged
Signature Signature
caner �ent Contractor
The fore oing instrument was owledged before me this J The foregoing instrument was acknowledged before me this
day o 1--.J ,20ZX=�byJC.�f� A Z f .20 by
who is personally known to me or who has produced who is personally known to me or who has produced
t-b As identification and who did take an oath:. as identification and who did take an oath.
NOTARY PUBLIC: OTARY PUBLIC•STATE OR FL(31t:Dr�'OTARY PUBLIC:
Sign: Hemandez Sign:
pmt; �-- DD476455 Print:
My o fission Expir ondedtic Bonding Co.,"I ac. My Commission Expires:
APPLICATION APPROVED BY: Plans Examiner
j Engineer
�/ Zoning
chc 05/13/03