PL-06-2175 Miami Shores Village fnG J- y h '
• - Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fag:(305)756.8972
BUILDING '"W fo " .A 9 PermitNo.�R
PERMIT APPLICATI01 9002 4 19nd Master Permit No.
FBC 2004
Permit Type(circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder)� EiJ4�asrPhone
Owner's Address. fl Op. 414
City_ / OfAPAf�5 State 0ld12-e'A el- Zip 3--3 /-5-W
Tenant/Lessee Name Phone#
Job Address(where the work is being done) 91O o oef E .4
City Miami Shores Village County Miami-Dade Zip 3.5/So
FOLIO/PARCEL# � /,� �j�
Is Building Historically Designated YES NO 1-�
Contractor's Company Name OewW A— Phone#
Contractor's Address
City. State
Qualifier Name __ UA WWGIS
AM
State Certificate or Registration No. ,, Certificate of Competency No.
Architect/Engineer's Name(if applicable) Phone#
�j Value of Work For this Permit$ ® Square/Linear Footage Of Work:
Type of Work: E]Addition� ElAlteratio E]New Repair`/Replace ElDemolition
Describe Work:
*".**Fees*,�*,�
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—X -334-
AUG
34-
AUG 2 2 PROD
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address o •.v.
City State J 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 not be approved and a reinspection fee ill be char ed
AS ignature Si tore
Owner or Agent �,�� Contractor
The foregoing instrument was acknowledged befor " The foregoing instrument was acknowledged before me this
day of � ,20 Y,by day of .20_,by
who is personally known to me or who has produced& �o�Ufg ll(_, who is peYsonally known to me or who has produced
NW� U f o�d As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: X95 NOTARY PUBLIC:
Sign: Si
Print: '_ Print:
My Commission Expires: My Commission Expires:
APPLICATION APPROVED BY: Plans Examiner
Engineer
Zoning
(Revised 02/08/06)