PL-06-1556 Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax: (305)756.8972
BUILDING D Permit No.
PERMIT APPLICATION u aster Permit No.
FBC 2004
Permit Type(circle): Building Electrical Plum g Mechanical Roofing
Owner's Name(Fee Simple Titleholder) tSNC\, ,ro e�('C��1�Phone#
Owner's Address 1 O L
City!" LA, - L� State r(-- Zip t
Tenant/Lessee Name Phone#
Job Address(where the work is being done) r q--
City Miami Shores Vill e County . Miami-Dade Zip 3 3
FOLIO/PARCEL#
Is Building Historically Designated YES NO_\4_
Contractor's Company Name_U Phone#
Contractor's Address
City State Zip
Qualifier Name Phone#
State Certificate or Registration No. CerRii f Competency No.
Architect/Engineer's Name(if applicable) -. Phone#
twoo
Value of Work For this Permit$77756 Square/Linea ;b ge Of Work:
Type of Work: EjAddition Alteration E]New Repair/Replace ❑Demolition
Describe Work: Qsc�% 0 :��_�A V ' CA CSC-2�
C_,Submittal Fee$ Permit Fee$ CCF$ (D` coo CO/CC
Notary$ Training/Education Fee$ 0-,(n_)0_ Technology Fee$
Scanning$'5 Radon$ DPBR$ Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due$ '� C)
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 terrify 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.
Signa a:2� Signature
Owner or Agent Contractor
The for oing instrument wasowledged before me this The foregoing instrument was acknowledged before me this
day f ,2 ba 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 P I NOTARY PUBLIC:
Sign: P Sign:
Print: rlenM
a Print:
WMMISS 5 M Commission Expires:
My Commission xpire Upired: S009
� Y P
Eo�tdc Tls�f►a-
APPLICATION APPROVED BY: � 99'a'�.ePlans Examiner
Engineer
Zoning
(Revised 02/08/06)