BP-03-1758FVOV
vF-D Miami Shores Village
2003 Building Department
- - - - - - - 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit No. P F ZW -J— 11 SE
BUILDINGCATIoNCA N C E L L
PERMIT APPLI D Master Permit No.
FBC 2001
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) ��� off ' t� �'Phone # �� "ISSZ, r6 i /A
Owner's Address Nl✓ � S�IIrrII 1
City
�r's I �4 � S State M� Zip l7 ? I -
Phone #
Tenant/Lessee Name
Job Address (where the work is being done)
City _ Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name l C 1 '_ Phone #
Contractor's Address
City
Qualifier.
Architect/Engineer's Name (if applicable)
State Zip
$ Value of Work For this Permit
Type of Work:
Describe Work:
Phone #
Square Footage Of Work:
Submittal Fee $160 , (A Permit Fee $,_ OV . CCF $
Notary $mil Jl1 Training/Education Fee $ �� Technology Fee $ Scanning S. Radon $ Bond $
Code Enforcement $ Structural Plan Review. $
��� 1���;
Total Fee Now Due $ r 36
(Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signatu�e Signature
`J Owner or A nt Contractor
The foreg`roiing' instrument was acknowledged
jbeefore a this r
e"
day of �� �^�- . 20 03, by �"en1� I I MUD_
who is personally known to me or who has produced 12OM-51
33 ^ As identification and who did take an oath.
NOT
Print: _ xpires:lu
ti
200
ndi
My Commission Expires: At ant'c Bong Co., Inc
State Certificate or Registration No.
The foregoing instrument was acknowledged before me this
day of
20 by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
(Certificate of Competency Holder)
Certificate of Competency No.
*************************************************************
APPLICATION APPROVED BY:
***********************************
NOV - 6 2003
Plans Examiner
Engineer
Chc10/14/03
Zoning
VILLAGE OF MIAMI SHORES
Located
BUILDING DEPARTMENT
OWNER BUILDER DISCLOSURE STATEMENT
being the legal
t
owner, for the
Legally described. as '
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the
State of Florida, F.S. 489.103(7),gnd I have read and t.~derstand the following disclosure
Statement, which entitles me to lrork as my own contractor, I further understand that I as the owner
must appear in person to complete all applications.
DISCLOSURE STATEME\'T
1 State law requires construction to be done by licensed ccutractors. You have applied for a permit under an
exemption to that law. The exemption allows yo=�, as the v;mer of your property, to act as your own contractor
even though you do not have a license. You must supervise the construction yourself. You may build or
improve a one -family -or two-family residence or a farms. out -building. You may also build or improve a
commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It
may not be built for sale or lease. If you sell or lease a buiding you have built yourself within one year after the
construction is completed, the law will presurr--- that you built it for sale or lease, which is a violation of this
exemption. You may not hire an unlicensed person as your contractor. It is your responsibility to make sure
that people employed by you have licenses required by state law and by county or municipal licensing .
ordinances. Any person working on your binding wbo is not licensed must work under your supervision
and must be employed by you, which mears that you must deduct F.I.C.A. and with -holding tax and
provide workers' compensation for that employee, all as prescnbcd by law. Your construction must comply
with all applicable laws, ordinances, building cc&s and zo_ng regulations.
Proof of ownership provided ( ) initial ofyr�e`v:=wing clerk. Tlid foregoing instrument
Was acknowled ed before me this _ ezy oft S(� , 20 _
By who is personally known to me or who has
Produced y L� ��' -- as identi�}f.�ation and who did take an oath.
6kner No
el Varpl,
``nave
Xpires. 23 9.
Owner- a Ju
Adam. $ �. That
nX Co., Inc
The Sunshine State
LKASNSE NUMBER
F326-U6-56-181-0
JOSEPH FRANCIS FITZGERALD
216 NE 97 ST
MIAMI SHORES, FL 331380000
BIRTH DATE SEX HGT. REST- ENDORSE.
06-21.66 M 6-02
ISSUED EXPIRES
DUPLICATE
03.30-M W21 -CS
09-29-99
SAFE RA/ER
of a motor vehicle constihthas consent m any sobriety bast required by law