ELECTRICAL1= i
. i f 1 PLU
it �,
BUILDING =
PERMIT APPLICATIO
FBC 2001
Permit Type (circle): Building
$ Value of Work For this Permit
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
ilding Department
0 52r 1
Code Enforcement $ Structural Plan Review. $
.E.2nd Avenue, Miami Shores, Florida 33138
el: (305) 795.2204 Fax: (305) 756.8972
Zip
Job Address (where the work is being done) /3Y' t/E 5
City Miami Shores Village
is Building Historically Designated YES NO X
Permit No.
&-°4'-- &og
Master Permit No. BP 04i-- 1Rw-
Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) 1 9--70 f-B COeil NCI E L Phone # 05 7$'?- .014
Owner's Address i /- 5 5'i E 't 4 42 'f'
City l4 t PM 1 State 1= L-
Tenant/Lessee Name
Phone #
Zip 3 3 '31
Square Footage Of Work:
"G.S Aio —7c4/
Cam.
County Miami -Dade Zip
Contractor's Company Name .` 1 ELer G°ichL ® ` w i ;SIC Phone # ` ! %'; / 326 - «/ 7
Contractor's Address q 9 C 5 57
City /y /;OMJ State rc,
Qualifier Z Qld' /s�
State Certificate or Registration No. Certificate of Competency No. 94 6 0000 59
Architect/Engineer's Name (if applicable) v G X. IV AN71e -44 Phone # (323 (75r- 73 Q,
Type of Work: ['Addition ❑Alteration New ❑ Repair/Replace ❑ Demolition
Describe Work: iL conc.. ,v N< /"/ /cjre y ,60) 77,p1
cep ez,Er j BY - i r,'
* * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ /i e CCF $ CO /CC
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ Zoning Bond $
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 7 9> -
Notary as to Owner and /or Condo President
My Commission Expires:
Date "� • Job Address 035 r `l'A -- c i r, . Tax Folio H - 3,IRC) (j\'i :7:Z. I 2
Legal Description / 14 £W J ® v � 0
Owner / Lessee / Tenan � i clinrd \l rtneJQ Master Permit #.219/7
Owner's Address 13,fS ( e_ 4 Phone ° F `;' :
Contracting Co. I`��':� -�"1 Address ` Z`
Qualifier Y/`Ctn L v ,SS# Phone g i9Y-q e C r
State # Municipal # Competency # EF: Va Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING E ECTRICA) PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
•
WORK DESCRIPTION
Square Ft. Estimated Cost(value)
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO 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).
Application is hereby made to obtain a permit to do work and installation as indicated above, and
on the attached addendum (if applicable). I certify that all work will be performed to meet the
standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
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. Furthermore, I
authorize the above -named contractor to do the work stated.
Signature of owner and /or Condo President Signat o o •
Date: Date: �+C�
■
t
Fire Other
Zoning Building
Mechanical Plumbing
e,e
JOSEPHINE CHURCH
name of Norar Publics ' 7W otary as to C t..rA c,Q �L- 111151 p.. ce&
y Commission Expires:
prOducccl
nda
DID take an oat li, or
ID NOT rake an oath.
** * * * * * * * * * * * * * * * **
FEES: PERMIT 3 o ®o
RADON C.C.F. 5 NOTARY_ tU TOTAL DUE 36;:5
e lectrical ,
Engineering
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE '795- 2a-Q
Date Z ( 107, Job Address
Legal Description/ 14 4 G ?L9 , O
nt T\
Owner / Lessee / Tena1ChQ d
3
5 OC: `-� _ Tax Folio
V er'neR Master Permit #,793/%V V
Owner's Address 135 (141t 64(4 Phone 1 ) - OR
Contracting Co. (J)Pe54 — (9 ( 2i'I '
- Phone Ql - cirri 3
State # Municipal # Competency # EF X C t Ins.Co.
Address
Architect /Engineer
Bonding Company
Mortgagor Address
Permit Type(circle one): BUILDING
WORK DESCRIPTION )d M d v 1 aP.Q.UIt a . j 4 , , ± mot() r u n e ( 4 F if
Square Ft. Estimated Cost(value) 45
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO 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).
Application is hereby made to obtain a permit to do work and installation as indicated above, and
on the attached addendum (if applicable). I certify that all work will be performed to meet the
standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
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. Furthermore, I
authorize the above -named contractor to do the work stated.
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
FEES: PERMIT 30/69 RADON C.C.F. 5
APPROVED:
Address
PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
icx:u61
Signat o
Date: /
I °..P. ►U
0
t_rl:
s
•
74
14 y +u,J , � tw• , SS ..i.
1 I I . 4' . t� .i II.
•.i 44'
a M,
JOSEPHINE CHURCH
ti ' 1 • name of Notar Public
otary /as to C. �� � B ed:
ET�:•� �Q� bo of . r
er � pr. uced:
y Commission Expires:
DID take an oat , or
It NOT take an oath.
** * * * * * * * * * * * * * *
**
NOTARY O TOTAL DUE 65
Fire Other
Zoning Building lectrical
Mechanical Plumbing Engineering