BP-04-1465 (2)Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
T' TECE N 5) 756.8972
BUILDING DEC 1 7 2004
Permit No.
PERMIT APPLICATIO , ----- - Master Permit No. n Pm it/ 64-
FBC 2001
Permit Type (circle): Building Electrical
Mechanical Roofing
Owner's Name (Fee Simple Titleholder) AMA-7/40A Phone # 4,1S 773 9933
Owner's Address 8 /v 1 a( Pr —
city t Ake`,, $ t4- .5' State PL._
Tenant/Lessee Name
Zip 711 3 E
Phone #
Job Address (where the work is being done) 576 A-/Cj 4 / 5 5-7--
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NOT
Contractor's Company Name
Attcps C (211il 6 wt+C� phone F
ntractor's Address A g A 1 ',kw to )7 _.U;
City ad e4L S P to 61f as State �L
Qualifier d/Cx .574("4-,7& /fZ
Zip
?' 3
c -'7<5'dsob
State Certificate or Registration No. C i t7 L 4 4.(e 3 g) Certificate of Competency No.
ngineer's Name (if applicable) /t`-- /k 04 ecI i✓` Phone # ) J % S Z 3, i
$ Value of Work For this Permit
V) 00 Square Footage Of Work:
Type of Work: ❑Addition jAlteration ❑New ❑ Repair/Replace ❑Demolition
Describe Work: p S PLyme- \Q
***********************�*Fees*****************************
Submittal Fee $ Permit Fee $ /6
Notary $ Training/Education Fee $ Pt
Scanning $ Radon $
ode Enforcement $
Technology Fee $
Zoning Bond $
Structural Plan Review. $
Total Fee Now Due $
CO/CC
(Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
f
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 t ttac ment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection hi occ rs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not b appr ed a a reinspection fee will be charged.
Signature
Ow or Ag
The fregoing instrument was ackn hedged before me thisv /—
day of Q(-T , 20 0*, by f''M9"Ub{i /4e l49-4?
who is personally known tome or who has produced
As identif ation and who did take an oath.
NOTARY P
Sign:
Print:
My Commission Expires:
************************
n t,
*****************************
APPLICATION APPROVED BY:
Chc 05/13/03
fL
'Y" ANA •A.?JA'cI1 ALEZ
1 .__ :r.,: •C c.V.4,2005
.._alive 0 I SC.rwril
**
Signature
Co tractor
The foregoing instrument was acknowledged before me this Si
day of iYn v,t r !r , 20 0 5 by A\ erg h,_ n ow h-I-z
who is personally known to me or who has produced f L I) (—
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
** ***************************
j
4 MY COMMISSION # DD 255963
P; EXPIRES: October 6, 2007
* W oittedloxy6iebee nderwriters
•tom
/t ` 2_ ®Plans Examiner
Engineer
Zoning