EL-04-260Miami Shores Village
Building Department
10050 N.E.2nd Avenue
������ Miami Shores, Florida 33138
Tel: (305) 795.2204
SVP ®9 2004 Fax: (305) 756.8972
BUILDING _ ®�� �' _ m .. — Permit No. —
PERMIT APPLICAT ON Master Permit No.
FBC 2001
Permit Type (circle): BuildingElectrical " Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) L1n�:s") Phone #
Owner's Address CIG , c 6o -
City. 0 , p y N 1:s 7_�)1 UAC 'S State 4- zip
Tenant/Lessee Name Phone #
Job Address (where the work is being done) C` _° -k-' 6W Ca .
City Miami Shores Village County Miami -Dade Zip 7�;5 ►');+
Is Building Historically Designated YES NO ti
Contractor's Company Name
Cont ctor's Address �e�-CK '1A1, -
City
Architect/Engineer's Name (if applicable)
Architect/Engineer's Address
City
State `�7 (_-
ki
State / Zip
$ Value of Work For this Permit*TMJ - 0 C)
Number of. Bays Stories Families
Type of Work: ❑Addition (�❑Alter(ation ❑New
Describe Work: L' (i--k� ,i\ �� 1 � Ci of -1 fa-(,��
Square Footage Of Work:
Bedrooms Baths
❑ Repair/Replace ❑ Demolition
D -
t
County Escrow Fee $ CEZ. C Permit Fee $ %®eP, r® O Notary $
Education/Training ?ee Tech $�a . S C7 Scanning $ n Radon $
Code Enforcement $ Bond $ Struct $
Minus Plans Check Fee $ Total Fee Now Due $ _..S �] 4
1 D (Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 roust
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 will be charged.
Owner or Agent
The foregoing instrument was acknowledged before me this
day 20 by
who n0
tato r w
As identification and who did take an oath.
Contractor
The fore oing instrument was acknowledged before me this `
day of 205 I by
wh persona y known to me whMranrEed
as identification and who did take an oath.
NOTARY UBLIC: NOTARY PUBLI
Sign:PSign: �_ 1 j -aa_ t� I
Print: rfli `J- 77 D. PE�Z Print: %L t D. PEREZ
My Commission Expires: ° E ! My Commission Expires: ��'�° E
*kn IMM
Sonde Notary Assn.,
mpetency Holder) w.nn.•..........
State Certificate or Registration No. Certificate of Competency No.
APPLICATION APPROVED BY:�®/✓®�����%®®/ Plans Examiner
Engineer
Zoning
Chc7/7/03
I
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SHAD. BE WITHIN 20 FW OF TWE _ LINE
(Cj OF THE 1YALGREENS LOZU ON THE FACADE