HC-08-1187 Miami Shores. Village,
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
BUILDING RECEI ® Permit No. KM—[M,
PERMIT APPLICATIU , � 2 ? Master Permit No.
FBC`2004
Permit Type: Mechanical �
Owner's Name(Fee Simple Titleholder) �1 L Z11
Phone# 76rl S • 6 3 7
3
Owner's Address S r � 7
City �l wv.t S� State "' Zip 03 43(.11;
-
Tenant/Lessee Name Phone#; t,�' o 17 5
E-MAIL:
Job Address(where the work is being done) ,S' 3j A4_r CftZr
City Miami Shores Village + County Miami-Dade Zip *3 3 f 3 6
FOLIO./PARCEL#: H' - 37AO. • 611
! Z
Is BuildingHistorically Designated YES NO,>�_ _
Contractor's Company Name. XoAol'f 54
Phone#_7.03' 0733
Contractor's Address =
GitY_ A• J StateZip /
Qualifier Name /P®/J®dlL� �i?i t 9-e Phone# --7,7? 79f X
State-Certificate o Reg1ton No. 4 ® ? Certificate of Competency.No.
-MAIL: ,¢
Architge gineer's Name(if applicable) Ate,_ C,p,,M,M _ P%ne# 7��'l• Z ) 1!i
Value of Work For this Permit$ 3 Square/Linear Footage.Of Work: �-
Type of Work: DAddition []Alteration aNew ❑ Repair/Replace El Demolition
Describe Work. i r^'+� r% 0(S 7 d f, Ad L Dl/C:r-" 7'a T GL43 r�k04ACK_
Sc ov AT 7t ,-_moi S fc
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Submittal Fee$ Permit Fee$_ CCF$ CO/CC
Notary$ Training/Education Fee$ Technology Fee$
Scanning$' Radon$ DPBR$ : _ Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due$
See Reverse side
Bonding Company's Name(if applicable)
Bonding Company's Address
.City State' - Zip
Mortgage tortder's.Name(if applicable)
Mortgage Lender's Address '
City State. , r, s Zip _
Application is hereby made tot obtain a permit to do the work v&tnstaiJatiops as;-indicatrA t certify,that no work or instaNation]rias
compi6hced 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 CONDI'T'IONERS,ETC..
OWNER'S AFFIDAVIT:1 I certify that all the foregoing information is accurate and that all'work will be done in cornpliance.with all
:applicable laws regulating construction and zoning.,,,,, , .
"WARNING TO dWNER: 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�wlth an,estimated value exceeding 82500, tha,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 art ent. o, a certified copy of,the recorded notice of commencement must,be posted at the job site
for the first i p tion w o s even (7) days after the.budlding 'permit is issues In the absence of such posted notice, the
inspectia ll not be r ed reinsp - ion ee will be charged.
Signatu Signature
Owner or Agent Con , o
The foregoin instrume ick wledged bef a me this The foregoing1fisirument was acknowledged before me this j
day of. 20 Q_by day of 20�`'8,by 4 A �PJ i
�vho is p rsonally known to or who as produced wholis personally'kng xo moor who has,produced
As identification and who did take an oath. as identification and who did take an oath:
)NOTARY PUBLIC: NOTARY P C.
Sign: Sign:
Print: f P Print•
Teres ,►aryls My Commissi k M672531
My Commission Expires My.,Ctmo�wI1sfm 09740886
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. Brania4TipuTwyFain �u
APPLICATION APPROVEU,BY: Plans Examiner
(, Engineer
7,oning
(Revised.-02/08/06)