Loading...
MC-10-991 Miami Shores Village Building Department artment MAY 2 8 2010 . 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 ' INSPECTION'S PHONE NUMBER: (305)762.4949 BUILDING Permit No.SIG 10 "q q l PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: MECHANICAL Owner's Name(Fee Simple Titleholder) lZow mQ Phone# 4-wco)�s—(DO-30 ' Owner's Address '0�� S T (4 0 6 City 10 rn ! State L Zip ?j t 1pt�; Tenant/Lessee Name ---- Phone# Email r 1012 r-Ot O ago D t l lsa4 t 'vifi-- Job Address(where the work is being done) "I ��j j � {1.f n &,y D City Miami Shores Village County Miami-Dade Zip FOLIO/PARCEL# Il- 3 Ir Go/y Is Building Historically Designated YES NO Flood Zone Contractor's Company Name G( V Phone# -anr 6% 96 L Contractor's Address t a q CA) fD Q1� OW C- City6244"A. State Zip Qualifier Name Phone# 1301 4%1 `9 State Certificate or Registration N Certificate of Competency No. Contact Phone 3W • m� a-eC14 CANPRft1 tu Architect/Engineer's Name(if applicable') Vni Phone# Value of Work For this Permit$ �t • U© Square/Linear FWRepair/Replace ge Of Work: Type of Work: Addition ❑Alteration [—]Neww rEl Demolition Describe Work: J ..Q" , Submittal Fee$-150!MPermit Fee$ ` v CCF$ W CO/CC$ Notary$ Training/Education Fee$ •OV Technology Fee$4-DO Scanning$ Radon$ DPBR$ Bond$ Double Fee$ Violation date: yy Structural Review.$ Total Fee Now Due$ See Reverse side-� 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 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 will be charged. SignatureA� I s Signature Owner or A o nt r/ ontractor The foregoing instrument was acknowledged before me this a 2i The forego' instrument was ackno ledged bef e me s�� da of 0 20 v b t9 CS i" S.q da of 20 ,'n b N1 Y �, Y Y , 111, Y , 1 , who is personall own to me or who has produced ,&gs 11',06Wt H:*, N rsonall known tlIolI me or who has produced As identification and who did take an oath. Z62i Atification and who did take an oath. NOTARY PUBLIC: GASRIEL EMESTO RIVERA TARY PUBLIC: ,,,,,, -6755 . . 3 3!29/201 i ?...tI u�Yijjrllin..n.w AiG►ni0 Si n: '� Sign: ..,f-�� I Prin. Comm#DD0656735 ; Print: • ,� Expiras 3/28/2011 M Commission Expires: ,3 /�� _ ;;F,, ° M Commission Expires'., w...::1:':.......:l ce:a Nctar::..�iei:::.l::.: y p m,t. APPROVED BY Plans Examiner Zoning Engineer Clerk checked (Revised 07/10/07)(Revised 06/10/2009)