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PL-06-247BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Owner's. Name (Fee Simple Titleholder Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Electric Plumbing Mechanical Roofing j7 L G �S 7 -- 1 -p Phone # C��J 3 3 2 - - Owner's Address et LS KI • • City M, l AM I Ste 1'I • Zip a3 a3 g Tenant/Lessee Name Phone # Job Address (where the work is being done) ( S City Miami Shores Village Is Building Historically Designated YES Contractor's Company Name 14 W t C )C7L„S Contractor's Address Z CoCD l A-) [ g � 2 City I N 1 t Lis J! 1 State - 1 . Qualifier 44 1 - a©.1) Z2 1 Q. State Certificate or Registration NogPOD2 6 Total Fee Now Due $ (Continued on opposite side) Permit No. q-- ®(O — 247 Master Permit No. PC o - 2A-3 y Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit Square Footage Of Work: Type of Work: ['Addition ['Alteration ['New ❑ Repair/Replace ❑Demolition Describe Work: �� t— l 1 * * * * * * * * * * * * * * ** *** * ** ** * ** * * ** * * ** * * * * * * * * *** * * * * *** Submittal Fee $ Permit Fee J a CCF $ 0. 60 CO /CC Notary $ Training/Education Fee $ 0.2...D • Technology Fee $ 4 ,03 Scanning 00 Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ 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 Ali IDAVIT: I certify that all the foregoin information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. t (- 0 "WARNING TO OWNER: YOUR FAILURE TO RE 'A /NOTICE OF COMMENCEMENT MAY RESULT IN YOUR B � PAYING TWICE FOR IMPROVEMENTS TO YOUR , P IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTbf TEIO BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." ************** * ** * ** ***** **** ********** ****** APPLICATION APPROVED BY: • chc 05/13103 Notice to Applicant: As a condition to the issuance of a building permit wiih`an a iimated value exceeding $2500, the applicant must • promise in good faith that a copy of the notice of commencement and constru ion lieeaaw brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded no eo mencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is is r ' the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of , 20 by , day of , 20 , by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: My Commission Expires: My Commission Expires: ************* * * * * * * * * * * * * * * * * ** * * * * * * * * * * * ** `✓, - 0 - (Plans Examiner Engineer Zoning