BP-05-1333Miami Shores Village
Building Department
10050 N.E.2nd Avenue Miami Shores Florida 33138L pf ''
Tel: (305)795.2204 Fax: (305)756.8972� I�����
BUILDING
PERMIT APPLICATI
FBC 2001
Permit No. B.1:05-1333
Master Permit No.
Permit Type (circle): Building Elect Plumbing Mechanical Roofing
e`t t cL a(,c ikdl k -
Owner's Name (Fee Simple Titleholder) Nr 6 L, Nok2Z Phone # ''S — 77L - ;C '
Owner's Address ((o C1, to q -421 .--t--.5z.,2,-
City 1 --AA ,I t j (j tate rl Zip 1 .
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 1)
City Miami Shores Village
County Miami -Dade
Is Building Historically Designated YES NO
Contractor's Company Name .1/60 e -f'/
Contractor's Address /5/ ,V / /63" 5-74
Zip
g'b asp ‘' y ce AL
Phone #j ®S 90.6 7 ?m-7- C -
City 2 7' ? - / State KL
Qualifier , _/v/G,,Z., . J//4 v
Zip
State Certificate or Registration No.
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit
Certificate of Competency No.
Type of Work: ❑Additi•n ['Alteration ❑New
,C�� v s
Describe Work:
e
Phone #
Square Footage Of Work:
/40
❑ Repair/Replace
❑ Demolition
****************************Fees******************************
Submittal Fee $ Permit Fee $ l 14"CCF $ 0 EO CO/CC
Notary SF') _O ) Training/Education Fee $ ®. 2.D Technology Fee $ Z.- 573
Scanning $ 3 C.0 Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. 5
Total Fee Now Due $ 1 4 . 30
(Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding Company_ s Address ;-
CityState
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
PAYINGTWICE ';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 be approved and a reinspection fee will be charged.
X Signature
Owner or Agent
The foregoing instrument was acknowledged before me this 23
day of AMI..* , 200f , by rot (cQA. 02, SO. rag eV,
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIICCC:
Sign:
Signature P4..
Contracitor
The foregoing instrument was acknowledged before me this 14
day of StP , 2066 , by > *-l-a. c D Lacei-
who is personally kno
NOTARY PUB IC•
Sign:
Print:
My Comm
Print: LE n t Ca. Sa rzS
My Commission C Expires:
o me or who has produced
ntificappri,and 4Pd gf th.
°` • ;'- Commission#DD23
Jul l , _007
4
Co.,
g,M+ Ena/ Camas************************** ** irSC�i reciYP9P114'#i4'IFXV:C PYCSFuFvFa�:aC�'e�F4C�F9YeYaF*****'ICnE•�L•nYeY1FaS'v@�'CdCikk�YdCuYi:'It**
a,► Expires April 04. 2008
sion Expires:
******************************************************
APPLICATION APPROVED BY:
Chc 05/13/03
********
***********
***********p****j*********************************
Plans Examiner
Engineer
Zoning