1089 NE 91 TerrBUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle). Building Electrical Plumbing Mechanical Roofing
ativitter's Name (Fee Simple Titleholder)
Owner's Address
Cit MjA i ._ � tate 4= r..._
Tenant /Lessee N21112
.bb Address (where the work is being done) I'Ce ( N E 'lei . Lam`. E `J
City Miami Shores Village County X Miami -Dade
Is Building Historically Designated YES NO
Contractor's Company Name ��� � /� � � i C z•','' pa;
Contractor's Address _ I C. ) /' r < ' e‘ G'' //
City `� �'- '— *C 4 S 1.
Qualifier ) r' /s �s f,, L- F -- L �.� '-. i �
State Certificate or Registration No. d C- ,f's/
Architect /Engineer's Name (if applicable)
$ Value of Work For this Permit
Code Enforcement S
Total Fee Now Due $
(Continued on opposite side)
4c i NE '-4
Miami Shores Village
Building Department
1 CO50 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204, Fax: (305) 756.8972
YIv ii-i t A 1)/ Grp Phone # � 3c ')
Phone #
Permit No. C- " ±�
Master Permit No.
•
Zip a .`)
Certificate of Competency No.
Phone #
Zip -,1 ,.
Zip
2
Square Footage Of Work: /e '
Type of Wort'' EtAtittidn ' ; .t- i kip ['New ❑ Repair /Replace
Describe Wbrk:
Q.A.,tetet 1 i /D 1 ,, , t.
'Tlf'
* **K * **** *,r* ** * ** *** * * *, * * ** Fees * ** * * * * ****** * * * * *** * ** * ** ** **
/6to Submittal Fee $ Permit Fee $ ' ter CCF $ �/ CO /CC
Notary $ Training/Education Fee $ / #36) Technology Fee $ 9 / J t,
3
Scanning $ .°"----. Radon $ Zoning Bond $ "°'
Structural Plan Review. $ —
emolition
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 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
COMM ENCEMENT."
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 broc ire will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commes cement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In e absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
s� /
ignature
NO T
Sign.
Print
My
wner or Agent
The foregoing instrument was acknowledged before me this y The foregoing instrument was acknowledged before me this
day of 17,1 , 20 " , by , day of ,ei "1 , 20 t� by .�: t I 4
: i ,
who ersonallly known me or who has produced wh ' personally known M
i p me or who has produced
As identification and who did take an oath.
r
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Tina
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�• 4Q�ii�t,� •,
Public - State of Florida
• ExpiresSep7 2M
EXpieataolsalon # DD247501
LIC•
* *****### ### ###### # # # # # # # # # # # # # # # # # # # # # # # # # # # # # ##
APPLICATION APPROVED BY:
Chc 05/13/03
NOTARY PUBtTC:
Sign.
Print:
My Co
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Contractor
as identification and who did take an oath.
* * * * **
##################### # # # # # # # # # # # # # # # # # # # # # # # # # # # # # ##
I..I.10LZs
Plans Examiner
Engineer
Zoning
Miami Shores Village
10050 NE 2nd Avenue
Printed: 5/18/2005
Applicant: CYNTHIA DAMON
Owner: DAMON CYNTHIA
JOB ADDRESS: 401 NE 94 ST
Parcel # 1132060140480
Signed: (INSPECTOR)
Building Permit
Phone: 305- 795 -2204 Permit Number: BP2005 -667
Contractor J M R CONSTRUCTION CO INC. Contractor's Address: 11690 NW 19 DR
Local Phone: 305 - 672 - 8055
Permit Status: APPROVED Permit Expiration: 11/1/2005 Construction Value: $500.00
Work: DEMOLITION FRONT PLANTER
Page 1 of 1
Legal Description: MIAMI SHORES SEC 2 PB 10 -37 LOT 13 & W1/2 LOT 14 BLK 52 LOT SIZE
Fees: Description Amount
FEE2005 -6336 Building Fee $100.00
FEE2005 -6337 CCF $0.60
FEE2005 -6338 Training and Education Fee $0.20
FEE2005 -6339 Technology Fee $2.50
FEE2005 -6340 Scanning Fee $3.00
Total Fees: $106.30
Total Fees: $106.30
Total Receipts: $0.00
: 2 C ?AD
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict
conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
CH*RIIP W. CARR
WIROPSINIZONtill& LAND UVS'!a*! & lNIR!
MAIL TO: PHONE (305) 221 -3416
9245 SM. 44 St. FAX (305) 5534403
MIAMI, FLORIDA 33165
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LOCATED IN:
eG O 011 SRORES-
MIA�MI DADF COUNTY FLQ1 !DA
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LOC ATION SKE L9.T DE'IMLS
SCALE: 1 INCH 100 FEET SCALE: 1 INCH a 20 FEET
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$ 'tvTt' SI I• ` Ifri' C•i:
PAGE _IL, MIAMI-DADE COUNTY, FLORIDA THIS SURVEY MAP L4 NOT VALID WITHOUT
THE SIGNATURE AND ORIGINAL RAISED SEAL OF THE FLORIDA LICENSED SURVEYOR
AND MAPPER. THE SIGNATURE AND SEAL CAN BE FOUND AT THE END OF REPORT.
THE MAP AND REPORT ARE NOT COMPLETE WTTHOUT THE OTHER.
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SURVEY NUMBER:03 -12 -015
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