BP-03-1257$ Value of Work For this Permit
(Continued on opposite side)
Total Fee Now Due $ /) 0 ,83
Mia ores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
f# � 7O ?04F
BUILDING NOV 2 5 2003
PERMIT APPLICA ;iIQN
FBC 2001
• (305) 756.8972
Permit Type (circle): : uilding Electrical Plumbing Mechanical Roofmg
Owner's Name (Fee Simple Titleholder) 1 zr'r`/ On %v e.(.5 1 I-r Phone #
Owner's Address 11300 N E 2..^-4 A tit_
City Al i Z,n1, 5 t n(E4 State ,FL Zip
Tenant/Lessee Name Phone # 305 al 9 -3 6 r1
Job Address (where the work is being done) /1 30 0 NE 2. AV e..
Permit No. ISP `3
Master Permit No.
City Miami Shores Village County Man-Dade Zip
Is Building Historically Designated YES NO l e
Contractor's Company Name L lewd 24A 6OOo6„►o`"e, erns t_, Phone # 384, 7 - 357o
Contractor's Address 6 1 9 N . 4 e_2A.. Si- .
City ' Pa y ►Z rgezcL state FL. zip 321 1 y
Qualifier / o a. Goode r,o C o a$79 Z-
of —Al d
Architect/Engineer's Name (if applicable) /Aix W o I CC 5 wrMZr\ A fc.1, . Phone # 305 ~ L/Y 1 " 1171
Square Footage Of Work:
Type of Work: ❑Addition ['Alteration DNew Repair/Replace ❑ Demolition
Describe Work: 196-e F�� Seti,L.c u, uKC c 2S�w� --
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * ** * * * *fr* COI e e ' zoo,
Submittal Fee $ Permit Fee $ 7 SO CCF $ IS /
Notary $ — Training/Education Fee $_5 Technology Fee $ ! i 7$
Scanning $ Radon $ Bond $ "
Code Enforcement $ ° Structural Plan Review. $ ,o
Bonding Company's Name (if applicable) A.o w G
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) ork
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 CONDMONERS, 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
inspectiorIll not be prove and a reinspection fee will be charged
f4 h a 1 tt too- Iti , vea.e..�i.{�&i 4
Chc 10/14/03
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this a5 The foregoing instrument was acknowledged before me this
day of Aokii, , 20 03, by fie 61.1 9° , day of A OV. , 200,.._1, by Acioci,Pw
who is personally known to me or who has produced who is personally known to me or who has produced
L/C,
As identification and who did take an oath. , _ identification and who did take an oath.
NOTARY : LIC: NOTARY PUBL
Sign: 1. s` �. � Sign: 214-7;4. ,4 41 ' .1/4-- -
Print: 61t Y G a,.€4,6•� - 2 1..„„01 � . M cninmi+¢cinn nnneoa37 ' �eL �,pl _
M Commission E xP Tres: gyres May 08, 2008 • My Commission Aires •
y
Print:
: a k ° MY Ccffirnissi° a May 08, 2008
(Certificate of Competency Holder)
State Certificate or Registration No. C.0 C Oz $ 7 2 Certificate of Competency No.
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APPLICATION APPROVED BY: Plans Examiner
ke Engineer
0)1/ Zoning