BP-05-115210050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING - Permit No 13P 5 - 1 L52-
PERMIT APPLICATION ; , aster Permit Nb.
FBC 2001
Permit Type (circle): Building Electrical Plumbing Mechanical
- o
Owner's Name (Fee Simple Titleholder) J ®/�jt) �� i))w TL// Phone #
Owner's Address 9 5 E Lf a.-04- Zit
City/� /am / SJi lreS State U
Tenant/Lessee Name
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO
Contractor's Company Name bae-a-e ^/ t / C
Contractor's Address — 7er ,U E, /04'
City /1 4 0441 gk -
Qualifier,, "Da.,
State Certificate or Registration No. 6. •05 7/4) °_,,. i ficate of Competency No.
Architect/Engineer's Name (if applicable) "� Phone #
$ Value of Work For this Permit 4 ;/ v vV S
Type of Work: ❑Addition
Describe Work:
f26 - PA-1 r-
** * *, * * ** * * * * * *• * ** * *, * *, F ees * * * * * * ** * * * * * * * ** ** ** ** ** * * **
Submittal Fee $ Permit Fee $ //) CCF $ /. 20 CO /CC
Notary $ 6 --.4" — /-- • Training/Education Fee $ .r 'T'v Technology Fee $ 2 •SV
Scanning $ 3 « ` - Radon $ Zoning 4nd $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $ ! / 2... (°.--
(Continued on opposite side)
Miami Shores Village
Building Department
['Alteration
Zip 3,J
Phone #
q (cc L ,c/& ewe__ LL
['New
Zip43 /3ff
Phone # 30 76
L<Repair/Replace ❑ Demolition
L k- Per rt6l,� l Fc.�� J2 oo -n -110 PreP eo> 56 rat
1- JS -LL mai) 1 F-1 6D P... P u
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
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 AN14IDAVIT: 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 ,the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee ill be charged.
Signature
NOTARY PUB IC
Sign:
Print: an
My Commission Expires:
APPLICATION APPROVED BY:
Chc 05/13/03
ie e,z 144
Owner or Agent
The foregoing instrument was acknowledged before me this
day of 7 ,( IS , 20 S by T A NG S GI v 1 bfo)l
who is personally known to me or who has produced
As identification and w o did take an oath.
Q31984
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Q r ' , �nr 1, ndin, c'
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Zip
Zip
• ignature
Contrac
going instrument was acknowledged before me this
, 20 _, by
who is per llb, known to me or who has produced
as identification and who did take an oath.
day
NOTARY PUBLI
Sign:
Print:
My Commission Expires:
***p***** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning