BP-05-682 Miami Shores Village
Building Department
t 10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305 56.8972
BUILDING"-� ..'�y�� Permit No. BP —(aU 2—
PERMIT APPLICATION �Po°:a ® � a er Permit No.
FBC 2001
Permit Type(circle): Buildin Electrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple TitleholdenL)lnOL . Phone#S
Owner's Address AJ L
City-'r'AWk State Zip
Tenant/Lessee Name Phone#
Job Address(where the work is being done)
City Miami Shores Villaize County ipp '-Dade Zip '
Is Building Historically Designated YES NO
Contractor's Company Name O W N Qf— Phone#
Contractor's Address -- -- --
City State
Qualifier
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name(if applicable) Phone#
$Value of Work For this Permit Square Footage Of Work:
Type of Work: ❑A on ❑Alteration ❑New ❑ Repair/Replace ❑Demolition
Describe Work:
Submittal Fee$ Permit Fee$ &O - w CCF$ 1 V CO/CC
Notary$� Training/Education Fee$ Technology Fee$ _
Scanning$ Radon$ Zoning Bond$
Code Enforcement$ Structural Plan Review.$
Total Fee Now Due$ &7,50 , !L - ��—
(Continued on opposite 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 n pproved and a reinspection fee will be charged.
Signature Signature
Owner or Agent Contractor
The foregoi instrument was aclqiowledged Wpm me this�'' /The foregoing instrument was acknowledged before me this
day of ,20 ,by �lci�ay of ,20_,by ,
who is person own to me or who has produced �r�a 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.
NOTAR PUB IC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
My Commission Expires: � °f"'`Sion ?)2 3 1 QJ4
Expires:Ju 3q 2007 My Commission Expires:
antic Bonding Co.
APPLICATION APPROVED BY: Af (l—� Plans Examiner
Engineer
Zoning
chc 05/13/03 G