BP-05-23613P
36
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Miami Shores Village
Building Department
10050 N.gE.2nd Avenue, Miami Shores, Florida 33138
Te : 5'2204..E4x: (305') 756.8972
FE2 7 6
BUILDING
PERMIT APPLICATIO
FBC 2001
Permit Type (circle):
Building
Owner's Name (Fee Simple 1 e older)
Owner's Address 7-53l
City`4f,(Q 1 / State ` Zip 73
lectricaj
r/ 5
Permit No.
Master Permit No. gie:= a,3,67
j7c /61
lumbing MechanicalRoofing
Phone #--7-s06-65-3-777/
Tenant/Lessee Name Phone #
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
905'o 77 d '4' 0,1
County Miami -Dade
NO
Contractor's Company Name \8 A- Phone #
Contractor's Address
City State Zip
Qualifier - et�
4
State Certificate or Registration No. Certs' ''.,y= ro Competency No.
Architect/Engineer's Name (if applicable) '°E iv/3 6 %(%/EV4. $ Phone # 78
$ Value of Work For this Permit
ig 29a
Square Footage Of Work:
�d2os,/pT
Type of Work: Addition ❑Alteration ❑New ❑ Repair/Replace
/❑ Demolition
Describe Wo k: T Os PQ' 4/e It 2,V/TS )&47-- ,p""
( Sez2/7c/ r/--oo/z,
****************************Fees******************************
Submittal Fee $ /0 ri Permit Fee $ CCF $ CO/CC
Notary 5 Training/Education Fee $ Technology Fee $
Scanning $ Radon $ Zoning Bond $
Code Enforcement $
Total Fee Now Due $
Structural Plan Review. $ 51)'d io -f .
(Continued on opposite side)
1,/-i/30(o)
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 build permit is issued. In the absence of such posted notice, the
inspection will not be app oved and a reinspection,fee will be charge'
\4CSO
Signature ��� w ire
Owner or Agent`, Contractor
The foregoing instrument was acknowledged before me s The foregoing instrument was acknowledged before me this
of 20
day , by day
of 20_, by
who is personally known to me or who has produced 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.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
My Commission Expires:
My Commission Expires:
*******************************************************4<***************************************************
APPLICATION APPROVED BY: Plans Examiner
Engineer
Zoning
Clic 05/13/03
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