BP-03-16941C94/-•
NI
Miami Shores Village
Building Department
RECEIVED
OCT 2 4 2003
)(,,,t,a 4 Id\roL
1000 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
BUILDING Permit No. bf 63- %(`l
PERMIT APPLICATION Master Permit No.
FBC 2001
Permit Type (circle): Buildi Electrical Plumbing Mechanical Roofing
k y.
Owner's Name (Fee Simple Titleholder)LORan.) K.ETVR- Phone # 305- -'?S8.- 6300
Owner's Address A v 6
City li✓1 IAM i S,taRCS State :Zip 3.3/
Tenant/Lessee Name 4 Phone #.'
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated
Contractor's Company N
Cityik‘inn. aEC K . A-) L4143 S-
LcQ
1 OP.
Address /
g'00 )3Y Ef\k) •
County Miami -Dade Zip Y O
YES NO
Qualifier
ee40
Architect/Engineer's Name (if applicable) . Phone #
Architect/Engineer's Address
Phone .305 ' L7 S-0-3
Zip 331'a
$ Value of Work For this Permit %300 • G2)1
Square Footage Of Work:
Number of: Bays Stories Families Bedrooms Baths
Da Repair/Replace 0 Demolition
Type of Work: DAddition DAlteration
Describe Work:
' t / r /
['New
CC--• /4.,_,) c7
07.E '►60
l
,1I 0 ****************************Fees******************************
County Escrow Fee $ .',._.7-1:771.75—L6*--- M� r `� Permit Fee $ /tai Notary $
Education/Training Fee $ £2 `T'V Tech $ a, L O Scanning $ 3 Radon $
Code Enforcement $ Bond $
Minus Plans Check Fee $ 572• - Total Fee Now Due $
Struct. $
(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 pe2t7must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANK andJAIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing inf
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECO
PAYING TWICE FOR IMPROVEMENTS; TO YOUR
CONSULT WITH YOUR LENDER OR AN A
COMMENCEMENT."
is accurate and that all work will be done in compliance with all
OTICE OF COMMENCEMENT MAY RESULT IN YOUR
ERTY. IF YOU INTEND TO OBTAIN FINANCING,
NEY BEFORE RECORDING YOUR NOTICE OF
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
Signature 'ii t ..Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this Z
The foregoing instrument was acknowledged before me this
day of 6 , 20 , by ._ Z 4,1 a ' Qf %4*' , 20 _, by
who is per an lly known to me or who has produced who is personally known to me or who has produced
As i tification and who did take an oath. as identification and who did take an oath.
NOTARX
Sign:
Print:
Mabel Vargas
s�.rnmmiccion fiDD231984
,�. qac lixpires: Jul 13, 2007 MyCommission Expires:
My Commission Expires: 9 �� xp
%.'FoFF.o �•� � Bonded "thio
************************** *s*t' *** ciika tt9Sig*IJW********************************************************
NOTARY PUBLIC:
Sign:
Print:
State Certificate or Registration No.
(Certificate of Competency Holder)
Certificate of Competency No.
*********************************************************************************************************
APPLICATION APPROVED BY:
Chc 10/02/03
OCT 2 4 2003 Plans Examiner
Engineer
Zoning