EL-06-563 Miami Shores Village
Building Department
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�CT! e 10050 N.E.2nd Avenue,Mami Shores,Florida 33138
,a 46 Vr-1 9I ]C*. Tel:.(105)795.2204 Fax:(305)756.8972
BUIL P ING ICEOVED Permit NoELX .I �o
PET APPLICATION SIR zoos Waster Permit No.
FBC 20 4
I
Permit T e(circle): BuildingEl 1 Pidnibing Mechanical Roofing
Owner's Name(Fee Simple Titleholder)A IkW- Cx)AITY Phone# y—h 93 r 01,
Q
Owner's Address 13 4 DNOq I UA66z hI 1AMi Fl— Z51,72
City A'IUl Staten�,. ziip
Tint/I.ess Name 0i� �lJ t ,�. Phone#
Job Address(where the work is being done) -t ®0 luc. zoo k& _
City ? Miami Shores Village County . Miami-Dade Zip /
FOLIO/PARCEL#
is Building fuCtorically Designated. YES NO__kc--
Contractor's Company Name - C. Phone# -3 I s �s
Contractor's Address 913 w VV I to 62:z
city State x:�L Zip 13 0 2 f
Qualifier N2 me Phone# 7 O33 1
State Cer ifi ude or Registration No. r C D®®2-13 of Competency No.
Architect/Es Name(if applicable)
7Value of work For this Permit$ '75 0 ` Square/Linear Footage OrWork: j 7
f .
Type of W rk: []Addition ❑Alteration ONewwoo<rz lace 0 Demolition
D ribs W o rk: 41 AI 10
—Ay ulAsT
AIJQ
f .
Submittal gee$ Permit Fee$ CCF$ 0•(00 CO/CC
Notary$ Tmining/Education Fee$ 0.20 Technology Fees Z
Scanning CO Radon$ DPBR$ Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due$ 04.so
See Reverse side
Bonding Company's Name(if applicable) Al 49 � I AIT J'
Bonding Company's Address
F
City State Zip
Mortgage Lender's Name(if applicable) AIA
Mortgage Lender`s Address
City State i 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 cert#W 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 IM Jap, r v and a reinspection fee will be charged
Signaturec�-L'A- Ln Signature �.
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of by day of �'( ,20 by /V1il�,�/li�P1C
who-is Hall known a or who has produced who i W�knownme or who has produced
As identification and oath.. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
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Sign; I r
Sign. C �IAEt:
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N,aUS121,2�7r � M.Iprint: Print: "
My Commission Expires: My Commission :' &4dftinoa,upuyPWOU
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APPLICATIONAPPROVED BY; Plans Examiner
Engineer
Zoning
(Revised 02/Ot3l06)
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