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FW-06-1313 Miami Shores Village Building Department MAY 19 2006 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 k� C3 / Y---) Tel:(305)795.2204 Fag:(305)756.8972 B Y: ? ______.____.��a BUILDING Permit No. Ohl OCA— 1313 PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type (circle): wildingElectrical Plumbing Mechanical Roofing �prXy Vf� Owner's Name(Fee Simple Title o er) n W Phone#":—=5y S Q]S-7-C=QC'J C. Owner's Address -Jq u facl all. r Of—I City_r-pAcA- r• l State��1 '� Zip �J� Tenant/Lessee Name Phone# Job Address(where the work is being done) City Miami Shores Vill e County . Miami-Dade Zip FOLIO/PARCEL# Is Building Historically Designated YES NO_Z 4<L-X;X Y Contractor's Company Name Phone Contractor's Address City State Zip Qualifier Name 1 Phone# State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name(if applicable) Phone# Value of Work For this Permit$ � n ,dv Square/EE Footage)f Work: Type of Work: []Addition ❑Alteration ❑New ❑ Repair/Replace ❑Demolition Describe Work: Submittal Fee$ Permit Fee$ �=65� CCF$ �a CO/CC Nota $-5• Training/Education ducation Fee$ CD•e Technology Fee 1'3' � gY $4 . 40 Scanning$ Radon$ DPBR$ Zoning$ Bond$ Code Enforcement$ Double Fee$ Structural Review.$ Total Fee Now Due$ A ®1® . 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. G°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 b Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this 1C1 _ The foregoing instrument was acknowledged before me this day of MQ 20 Cf9by ZUj,4 y yALfXZ day,of. .20_,by who is personall 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 P NOTARY PUBLIC: t W abe Sign: Sinn 9)� 4 _ Sign: Print: i' Print: r,,, i Ett nBiH�Co.,Inc M Commission Expires: My Co ission Expires: y xP APPLICATION APPROVED BY: Plans Examiner Engineer S /y Zoning (Revised 02/08/06)