FW-06-1030 3 Miami Shores Village MV MIETMI
Building Department AN 21 2006
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 �� �
�(® l l ?--s3Af'j Tel:(305)795.2204 Fax:(305)756.8972 �`... .�A-_--__
BUILDING Permit No. f(A6C)(o' 1030
PERMIT APPLICATION Master Permit No.
FBC 2004
Permit Tyke (circle): (BDufflding Electricals Plumbing Mechanical Roofing
Owner's Name(Fee Simple Tio r r ) e I`1 c.Q Phone# 30s- 77 g t} • S��.5
Owners Ala-,y;
cSh/4�' /yfy 10:5
C
City/ala-,y/ OrPs State Ft- Zip 3315 0
Tenant/Lessee NameN! Phone#
Job Address(where the work is being done)
City Miami Shores Village County . Miami-Dade Zip
FOLIO/PARCEL#
Is Building Historically Designated YES NO-
Contractor's Company Name aft;,e t c• hone# aS• �cj • S���
/OS
Contrac is Address �
City /- A t. S hp r Q s State R, Zip 33 / 50
Qualifier Name Phone#
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name(if applicable) Phone#
Value of Work For this Permit$ Square/Linear Footage Of Work: �00 .
Type of Work. ❑Addition ❑((A''lteration *New [:1Repair/Replace El Demolition
Describe Work: Cha!n 110%k Ter C e. 010 n C we-&+ P Q!f_4?tnae r-Es,_
Fees
Submittal Fee$ Permit Fee$ �Uy ��. CCF$ d. (=Q CO/CC
Notary$ CQ Training/Education Fee$ ,Z Technology Fee$ Z
Scanning$ • Radon$ DPBR$ Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due$ t
See Reverse s' PAID
Bonding Company's Name(if applicable)
n
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 w'll not be approved and a reinspection fee will be charged.
r
Signatur Signature
Owner or Agent Contractor
The fore oing ins�trument was acknowledged before me this�1 The foregoing instrument was acknowledged before me this
day of \ 20 by r 1� 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 and who did take an oath. as identification and who did take an oath.
NOTARY UBL C: NOTARY PUBLIC:
Sign: Mabe afgas , Sign:
Print: u113,2O0Print:
9_•...- 7d�Y1 ,r 4i
My Co ission Expires: ... rla, tiding Co.,Inc. My Commission Expires:
APPLICATION APPROVED BY: Plans Examiner
Engineer
Zoning
(Revised 02/08/06) a.-