BP2003-1753 CanceledWEci7v � Miami Shores Village
NOV 0 5 2003 Building Department C fie, Y bl-aooq
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
5 Permit L gc:.E8972itNo.V
BUILDING ► e-?( k a .6 y Mr--7--y//, • /9 s PP,2Q03 -1l53
PERMIT APPLICATION Master Permit No.
FBC 2001
Permit Type (circle): Building Electrical Plumbing Mechanical / Roofing�
Owner's Name (Fee Simple Titleholder)
�SCL�rC�V�L(�� Phone#
Owner's Address I `i D ! V
City I� <�A 1, :e'5 State
Tenant/Lessee
Zip
Job Address (where the work is being done) 4 o A V
City Miami Shores Village County Miami -Dade Zip 7
Is Building Historically Designated
Contractor's Company
Contmctor's Address _
City
YES
Architect/Engineer's Name (if applicable)
V
$ Value of Work For this Permit
I000.
Type of Work: 4Addition ❑Alteration
Describe Work: Lt�
NO
aA eK Phone
Square Footage Of Work:
KR air/Replace
Cq r
01
Ci. 3 q&-- . ............................Fees..............................
Submittal Fee $1:;)-() . (]Q Permit Fee S lac CCF $ 060
Notary S 5 Training/Education Fee $ o oZ Technology Fee $
Scanning $ S �— Radon S. Bond S
Code Enforcement
Total Fee Now Due S
Structural Plan Review. S
❑ Demolition
(Continued on opposite side)
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
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 ofthe recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (I) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be a roved and a reinspection fee will be charged.
Signatur Signaturejl t ) \LW10
Owner or Agen Contractor
The foregoing instrument was acknowledged before me this�. The foregoing ent was acknowledged before me this
day of}'()I(. .20122,by WQQ1- 20fQCA( S day of •200 . y�1 KdCty aZZAL
who is personally known to me or who has produced who ' ersonally kno to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NUI'AK P LICf NOTARY PUBLIC:
Sign: �' ' 84 Sign:
Print: - pi s: Jul 13, 2007 Print: Steve P Goy
My Co 'ssion Expires: Atlantic Bonding Co., Inc. - M yxMy CommWion DD244M
y Co • w Ezpires Auyust 28. 2007 _
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No
APPLICATION APPROVED BY:
NOV — 6 2003 Plans Examiner
Chc 10/14/03 Zoning