WS-7-260 Miami Shores Village
Building Department 0�ljm�10050 N.E.2nd Avenue,Miami Shores,Florida 33138 p16f
Tel:(305)795.2204 Fag:(305)756.8972
BUILDINGD 'CO "'YPermit No.
PERMIT APPLICATION FEB 4 2007 aster Permit No.
FBC 2004 BY:._I_1 � �......,�®
Permit Type(circle): Building Electricals Plumbing Mechanical Roofing
Owner's Name(Fee Simpler) GrC// � SLI X DYI Phone#
Owner's Address 996 IX-741, Ave. RC
City ` /lfri i ,51?D1'fS State �L Zip .��/�6
Tenant/Lessee Name Phone#
Job Address(where the work is being done) (9 A// �XAA__ j .
City Miami Shores Village County iami-Dade Zip &3/-q8
FOLIO/PARCEL#
Is Building Historically Designated YES NO
`/Contractor's Company Name , Phone#
Contractor's
�Afddress /
1
City to,_ '4'tL Zip
Qualifier Name Phone#
State Certificate or Regis 'on No. Certificate of Competency No.
Architect/Engineer's Name applic e) Phone#
Value of Work For this Permit$ �T �� Square/Linear Footage Of Work:
Type of Work: ❑Addition QAlteration >�ew ❑ Repair/Replace ❑Demolition
Describe Work: ��'/
Submittal Fee$ Permit Fee$ f CCF$ CO/CC
Notary$ _ Training/Education Fee$ 0_q1J Techuology Fee$
Scanning$ Radon$ DPBR$ Zoning$
Bond$ Code Enforcement$ Double Fee$ 1
Structural Review.$ Total Fee Now Due$ ��,�• �
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.
"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 no approved an reinspection fee will be charged.
G t
Signatur Signature vis 15Z,
Owner or Agent rr�� Contractor
The for%oingpinstrument was ac owle ged before Mme this (J The foregoing instrument was acknowledged before me,ttthis l'�J
day of �YJ ,20 d� b� 1< «X� . day o 20aby �1►Ct- plibyxj,
who is personally known to me or who has produced who is personally known to me or who has produced
//
v`-lJ As identification and who did take an oath. as identification and who did take an oath.
NOTARY P C: 1�vYabeIl Marga NOT AR UBLIC:
i�Yabe>t Varga,
r=. Co mission#DD231'98a ',a� ° •.�,_ ommission#D 198
xpires:Jul 13,200 r �= 3,200
Sign: ;e° BondedThru Sign:
1 i lantir Rnndine Co..Inc o�F9FR edqqiru
Print: Print: Atlas ,nrlinn('n Pr+-
My Co Sion Expires: My CoLunission Expir
APPLICATION APPROVED BY: Plans Examiner
Engineer
Zoning
(Revised 02/08/06)