RF-06-728 Miami Shores Village � �®
Ja . . Building Department M R 1 2005
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 ----
Am Azoi I t Tel: (305)795.2204 Fax: (305)756.8972 - -
BUILDING Permit No. I1T
PERMIT APPLICATION Master Permit No.
FBC 2001
Permit Type(circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder) zj-01=— sT/e ze7 Phone
Owner's Address 106 99 NE/aAJ,�
City 2� T state/—'/- . Zip may- z9
Tenant/Lessee Name /(/� Phone# �✓�
Job Address(where the work is being done)
City Miami Shores Village County Miami- ade Zip
Is Building Historically Designated YES NO
Contractor' �n -
s Company Name® /9 Phone# ✓�/c� /�� �
Contractor's Address
City Zip
Qualifier
State Certificate or No.Registration �� "� 9 cate of Competency
g No.
Architect/Engineer's Name(if applicable) 6/ Phone# iLA
C,
$Value of Work For this Permi/•5�0•
Square Footage Of Work:
I
Type of Work: DAddition DAlteration New lace
Re air/Re
p p ❑Demolition
Describe Work: ►' J"/Q�/�- �C77f -AA4;4S &1XJ 6064", c mkw
Submittal Fee$ Permit Fee$ CCF$ CO/CC
Notary$ Training/Education Fee'$ Technology Fee$
Scanning$ Radon$ Zoning Bond$
Code Enforcement$ Structural Plap-Re w
r
Total Fee Now Due$_ ,
(Continued on opposite side) MAR 3 1 008 -
45VL
Bonding Company's Name(if applicable)
Bonding Company's Address
City State/
ta Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City 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
or the he 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 an a einspection fee will be charged.
Signature Si0,
gnature
ent Contractor
The foregoing instrument wa a rnowledged before me this The foregoing instrument was acknowledged before me this
day of&Ae j ,20 4%,by fie eaj4 j'[Jn day of MkL�iir 20 04,by061tl t1 & ,
who is personally known to me or who has produced L Nd who is personally known to me or who has produced
� Y
As identification and who did take an oath. as identification and who did take an oath.
NOTARY UBLIC: NOTARY PUBLIC:
Sign: An Sign:
Print: 11 111/// Print: �rj i-a
My Commission Expires: p�F\�5�.•'�•%•SSFcS%'jgii�,. \����QQ1•,•..:.. iii
My Commission Expires 5•.• , 10N••.Tq �i�
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i o• .o� y #D0138328
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APPLICATION APPROVEDL'1SA�t/PeCub'•lrSc TUnAaSe��E��:��+��v��;� � �/ri��'OGg•�••!kS•UT•nA•dW•o . �Q
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xaminer
Engineer
Zoning
chc 05/13/03
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