BP05-149 Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax: (305)756.8972
BUILDING
CII�uv�[����� Permit No. f5POS-lU 9,
PERMIT APPLICATIO ® Z Master Permit No.
FBC 2001 , �,
Permit Type(circle . Building Electrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder "X � OL�' '� C.' ��"�' Phone#
Owner's Address t Xoo IntG XO:5 S"r �Sos- �tS►- L a a. cC,
City2s!t S1io,F.;.s St zip 3�t3g
Tenant/Lessee Name Phone#
Job Address(where the work is being done)
City Miami Shores Village County Miami-Dade Zip 33 13
Is Building Historically Designated YES NO it
Contractor's Company Name Skp�. �7 t�"&6 `.boa r-S Phone# 3a S-
Contractor's Address tS")t S S _bl)4e �Wy SuZXG 41%-%
City 4z�v Vu State C(� zip 331 S
Qualifier �'JPQ ObR. f A)C
2
State Certificate or Registration No. Certificate of Competency No. �'i rJ V s3
ArchitectlEngineer's Name(if applicable) ( Phone#
$Value of Work For this Permit ' a.®8 a Square Footage Of Work: moo®K.
Type of Work: []Addition [__]Alteration ONew E/Repair/Replace ❑Demolition
Describe Work: i rL-4c c yar'll"c- G0vr-"G,CbD®R- W1ZN NEW C.L t-1, 1KSW"_1CD
�8n1�C., 3.1.�5•T.i LL ` lr1F'C�1RSS E� CsP�c.I+GG De®R- dPE�'G�c.� t ��
Submittal Fee$ �•OGS Permit Fee �/Q�`'® CCF$ ® CO/CC
Notary S TrainingfEducation Fee$ [;/s�-/'V Technology Fee$ /S®
Scanning S Radon$ ' Zoning Bond$ "'—
Code Enforcement$ Structural Plan Review.$
Total Fee Now Due$
(Continued on opposite side)
-a.
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's-Name(if applicable)
S FP R.G 8
c
Mortgage Lender's Address a • �� X03 0`-�
City ES t'W 1"Fi S State ZY ht zip 5636 L
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 allthe foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and all.
- "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 x'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 reins ection fee will be charged.
Signature (21
Owner or Agent 1010, Contractor
The foregoing instrument wasow edged beforeme this c� The foregoing instrument was acknowledged before me this_.Vr
day of yfJ b 2015 by ' n W i day of O/ ,200 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.
NOT P LIC: NOTARY PUB
Sign: Si �� Of
Print: :d�p"rv': # D231984 per; /l S _2Z
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=� *=E ires•Jul13,2007
My Commission fres: A9 -i f � Bonded Thai tYn My Commission Expires:
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APPLICATION APPROVED BY: X07 35
Plans Examiner
Engineer
Zoning
Chc 05/13/03