BP-04-1471MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date 1? V &W Time
Type Insp'n R'iil * l 564
Permit No. / c3- l`'7 /
Name
Address
Company
ov A9E
kve
Phone #
For Inspectom 2 Name & Date
Approved
Correction
Re- Insp'n Fee
BUILDING
PERMIT APPLICATION
FBC 2001
'Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 7952204
Fax: (305) 756.8972
e
PermitlVo —
�.
Master Permit No.
Permit Type (circle): nildin Electrical Plumbing Mechanical Roofing
SARI``f U NI, %-(--\/ / / Phone # 305 g / ?78 ge
Owner's Name (Fee Simple Titleholder) I
Owner's Address 1 t 300 u, E, 2 ^�° AVE
C i t y M t o n l h o reS S t a t e 1 L e Z i p 3 3 1 6 1 — 6628
Tenant/Lessee Name Phone #
Job Address (where the work is being done) w Z ND AVG 9 8 E IM i I t 4- 115' -
City Miami Shores Village County Miami-Dade Zip
Is Building Historically Designated YES NO % i-
Contractor's Company Name - / SA/ �Od r�� Phone # 56 q 65 3'7 q q
Contractor's Address 9Z 4 7 �i4-6. ova /'/Ic/A,
City LAIC 44 State PL Zip Jf 76 2
Qualifier pry, S I e t
Architect/Engineer's Name (if applicable) - Phone #
Architect/Engineer's Address
City .�
State
$ Value of Work For this Permit $ "4 2 5 n ( LI
Number of: Bays Stories Families
Type of Work: ❑Addition ❑Alteration @New
Describe Work: cr 'e, S
e - 4c on pikle 2 Ave,
Zip
Square Footage Of Work: o o
Bedrooms
❑ Repair/Replace
?Ott MicilA
County Escrow Fee $ 1 • ,() Permit Fee $ (00.00 Notary $ C illq1Cf. 3 ) 040
Education/Training Fee $ Tech $ Scanning $
Code Enforcement $ Bond $ Struct. $
Minus Plans Check Fee $ Total Fee Now Due $
****************************Fees***************************
Baths
❑ Demolition
eliJa,(K
Radon $
(Continued on opposite side)
74,2 co L c
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 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
inspection will not be approved and a reinspection fee will be charged.
Signature
APPLICATION APPROVED BY:
chc7n /o3
NOTARY PUB
Sign:
Print:
Owner or Agent
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: My Commission Expires:
(Certificate of Competency Holder)
C Certificate or Registration No. /3 C 0 Cr 7/ ertificate of Competency No.
*************► i * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Contractor
The foregoing. mstrument was acknowledged before me this ±h,
day of P relief; 2003,
who is per ^� t or who has produced
as identification and who did take an oath.
( .
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W
************** * * * * * * * * * * * * * * * * * * * * * * * * * * * ** **
SEP 1 0 200 tans Examiner
Engineer
Zoning
L Schwartz
00344
Mantic Banding Co., Inc
N.W. 2nd Avenue
N.W. 2nd AYE
N.W. 2nd AVE
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