1100 NE 91 Terr (2)1 / Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING Permit No. , 'v q / ( • 1 .
PERMIT APPLICATION Master Permit No.
FBC 2001
4
■
■ Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
?c Owner's Name (Fee Simple Titleholder) t , . , •i y,,1' ;' Phone # ���,
Owner's Address , ; ' /` 1- ("
City ` �,"
Tenant/Lessee Name
/X Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
Notary S
Miami Shores Village
Total Fee Now Due $
(Continued on opposite side)
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
State Zip _1/4/
I
County Miami -Dade
NO
Phone #
Zip -
Contractor's Company Name Phone #
Contractor's Address
City State Zip
Qualifier
Architect/Engineer's Name (if applicable) Phone #
S Value of Work For this Permit - Square Footage Of Work:
Type of Work: EAddition f Alteration Limey [ Repaii/Repiace E Demolition
Describe Work:'
_ •
Submittal Fee $ „ 9 Permit Fee $ X t10� CCF $ CO /CC
Training/Education Fee $ d Technology Fee $
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ ti < ! e••• -.OA. Plan Review. $
a
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
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 it ti U 0 l,' / , . 1 /-\ � �'�" c; 4- � Sigratu , , •4 Y` 1
Owner or Agdnt / Contractor
The foregoing instrument was acknowledged before me this =% The foregoing instrument was acknowledged before me this 3
day of , ;Qr;_ i , 20 Q V by , day of :% 1 ( -- , 20 O . , by
who is . sonally kno 2jo me or who has produced who ifpersonally known me or who has produced
_r 1�
as identification and who did take an oath.
NOTARY P JBLIC: � PUBLIC- RY PUBLIC-
Sign: `I-N,:- / - -1 11 / - Si / .i t % V�,;✓ i- �) /
Print: / _ h'''it' , - :)¢ i'; #1 Print: , _ 'N > /l r 'f (- P )/,/'/-b-'
My Commission Expires: My Conunission Expires: Shany * * * * * * * * * * * * * * * * * * * * * ** ** w 'i ' t A * ***** * ******** ****** * * * * **** * * * * * * * * * * * * * * * * * * * * * **
• \ Empires i l e of Competency Holder)
as ExPims Se i r G„., i t,.
State Certificate or Registration No. = C. t„ ( ; (; Certificate of Competency No. It-) ,
As identification and who did take an oath.
***************************************************,/** , JO* APPLICATION APPROVED BY:
r Ti004
Chc 12/15/03
* * * tgti ** * * * * **
q My Ccrn::r-s;cr, 00058318
Exp:':;t3 September 11, 2005
Plans Examiner
Engineer
Zoning
Miami Shores Village
10050 NE 2nd Avenue
Building Permit
Phone: 305- 795 -2204 Permit Number: BP2004 -287
Printed: 3/8/2004 Page 1 of 1
Applicant: CHARLES JOHNSON
Owner: JOHNSON CHARLES
JOB ADDRESS: 1100 NE 91 TERR
Contractor ALL DADE POOLS, INC Contractor's Address: 681 SW 2ND CT
Local Phone: 305 - 828 -6363
Parcel # 1132050010390 Legal Description: WATERSEDGE
Fees: Description Amount
FEE2004 -2388 Building Fee $200.00
FEE2004 -2390 CCF $1.80
FEE2004 -2392 Scanning Fee $3.00
FEE2004 -2393 Training and Education Fee $0.60
FEE2004 -2394 Technology Fee $5.00
FEE2004 -2395 Code Enforcement Fine $100.00
Total Fees: $310.40
Permit Status: APPROVED Permit Expiration: 8/30/2004 Construction Value: $2,100.00
Work: POOL RESURFACING
Signed: (INSPECTOR)
PB 9 -141 LOT 13 & W1/2 OF LOT 14 BLK 2 LOT
Total Fees: $310.40
Total Receipts: $0.00
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: