FW-06-1238 Miami Shores Village
e D
BuildingDepartment b p MAY 12 2006
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
4 ) Tel:(305)795.2204 Fax:(305)756.8972
BUILDING Permit No. FVU®(0— 1
PERMIT APPLICATION Master Permit No.
FBC 2001
Permit Type(circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple i e older) _nVU jt-® VLgCj-A&CY- Phone#
Owner's Address�Z__ t-(,5 e)C—,7 q g
City. 'f,')YW--6 State _ Zip
Tenant/Lessee Name Phone#
Job Address(where the work is being done)
City Miami Shores Village County Miami-Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name Phone#
Contractor's Address
City State Zip
Qualifier
State Certificate or Registration No. t oompetency No.
lip 0
Architect/Engineer's C
eer s Name(if applicable) hone#
$Value of Work For this Pei-14N-1–Lob
er 1ob -—0D
Square Footage Of Work-4-
Type
ork-Type of Work: ❑ ddition ❑Alteration ❑New XRepair/Replace ❑Demolition
Describe Work: rices (�p e
Submittal Fee$ Permit Fee$ ?/S� CCF$ CO/CC.
Notary$ t Training/Education Fee$ Technology Fee$
Scanning$ S-CO Radon$ Zoning Bond$
Code Enforcement$ Structural Plan Review.$
Total Fee Now Due$ • i e�
(Continued on opposite 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
Signature Signature C Z4 --Z—
Owner or Agent y Contractor
The foregoing instrument was acknowlZ
d before a this y The foregoing instrument was acknowledged before me islt",-
day of 20&.by A �' � C�L� ..?! day of 20 by � �e�
who isrsona y kno- to me or who has produced who is p onally known me or who has produced
As i n ification and who did take an oath. as identification d who did take an oath.
NOT NOTARY PUBLIC:
PL Sign:
Print: C ,// n
Print:
c
My Commission E ires: W C-5Caceres My Commission Expires:NOTARY PUB1 IC•STATE OF FLORIDA
Y pS38 22 I'dia Caceres
0111155®1 �2
W I
llet�ded AtAtSc Bonding Co.,Inc. Bended T m Atlo'dC Bonding Cs
Inc.l
7APPLICATION APPROVED BY: Plans Examiner
Engineer
5
6-
C, Zoning
chc 05/13/03