RF-08-676 M1, iqMiami Shores Villa e
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Building ul ding Department
10050 N.E.2nd Avenue,Miami Shores,.Florida 33138
Tel:(305)795.2204 Fax: (305)756.8972
BUILDING 7W-7` Permit No.
PERMIT APPLICATION "
FBC 2004
a�� aster Permit No.
Permit Type(circle): Building oofing
Owner's Name(Fee Simple Titleholder) l�i,"Ma �A. 2 Phone# 4Wti86'Sy3'9$(0S-
Owner's Address �� �� P�r—
Ciry M%NlN ti SN&ftf_ State C-t, Zip Z 1V 1
Tenant/Lessee Name q1A Phone# 01A
Job Address(where the work is being done) SA,m re
City Miami Shores Village County Miami-Dade Zip
FOLIO/PARCEL#
Is Building Historically Designated YES
Contractor's Company Name A6 a— Phone#
Contractor's Address
City State
Qualifier Name Phone#
State Certificate or Registration No. -lam Certificate of Competency No.
Architect/Engineer's Name(if applicable) %a Aw/\ Phone#
O C� c
Value of Work For this Permit$ '200 . Square/Linear Footage Of Work: �`� 19V% '
Type of Work: ❑Addition ElAlteration ❑New [JKRepair/Replace ❑Demolition
Describe Work: %& L,L Q{%_VI? AgqcW 12--24 hp sm L Sipa l���s aM� td0
e0—ar-ex"- 4"&!% c�:�S�rnt� std Arles_ S-claj 'S� p�4•�T
Submittal Fee$ Permit Fee$ ��lJCCF$ CO/CC
Notary$ ✓' Training/Education Fee$ U• Technology Fee$ 'c
Scanning$ Radon$ DPBR$ Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due$ �U 1 • ��
See Reverse side—4
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 aiad,that ail -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-7A Signature
Owner or Agent W!&**. L•CA~t Contractor
The foregoing instrument was acknowledged before me this 1% The foregoing instrument was acknowledged before me this
day of AOT;1 .,2%]L,by iL.C day of ,20_by ,
who i< ersonall known o me or who has produced who is personally known to me or who has produced
As identification and who did taka;au oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
NOTARY PU-,J -ST, OF FLORIDA
'))UgSteven Robert Schlegel
Sign: Cotnmission#DD414766 Sign:
Expires'.
Print:a=e"de :.t?antic Boa �B�o.,�a Print:
My Commission Expires: LIN f goo My Commission Expires:
APPLICATION APPROVED BY: eo Plans Examiner
Engineer
Zoning
(Revised 07/10/07)