BP-05-795BUILDING
PERMIT APPLICATION
FBC 2001
/r ^ J � � x, Mechanical
Owner's Name (Fee Simple Titleholder) h I t7 11J C 5 ✓�9 Phone #6Q� r Or (
Permit Type (circle):
Building
Owner's Address /04 ( 0 ftly ( i t' 4
City ;1(A-61u State 4' Zip
Tenant/Lessee Name NIA
Job Address (where the work is being done) /D‘ 16 t4, 1 `
City Miami Shores Village
Is Building Historically Designated
Contractor's Company Name
Contractor's Address
City
Qualifier
State Certificate or Registration No.
Architect/Engineer's Name (if applicable) OA-
$ Value of Work For this Permit
Type of Work: ['Addition
Describe Work:
Total Fee Now Due $
Code Enforcement $
ki/A- SEtf-coat
5 vv
Submittal Fee $ Permit Fee $
Notary $ 5 Training/Education Fee $
Scanning $ 3 °
Radon $
(Continued on opposite side)
6(.3®
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: 09U 204 Fa : 305 756.8972
RE
MAYe
YES
b ap_ 0
❑Alteration
Electrical
ty Miami -Dade
— 4 4 ;
i - -
Structural Plan Review. $
e
Plumbing
Permit No.i
P 0 s-�g5�
Master Permit No.
._3(3g
Phone # AVA
Phone #
Phone #
Zip 3 3(38'
❑ Repair/Replace
Roofmg
Certificate of Competency No.
Square Footage Of Work; f 2) SQ r . 'a X Az IL.
❑ Demolition
1 _. , ,, s . I / ' ' AL' 11.
_.
/ 1 '
* * *** ***F * ** * * * * * * *** ** * * ** * * *** * ***
� �� er
d CCF $ . bb CO /CC
b Technology Fee $ 4
Zoning Bond $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
Signatur
My Commission Expires:
APPLICATION APPROVED BY:
Chc 05/13/03
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.
enced prior to 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 sev n () d s after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a rein ffet• e ill be charged
NOTARY PUBLI - /
Print: - i EIWAWANI
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * **a*
Owner or Agent Contractor
e foregoing instrument was acknowle gel before me.� 's T o o a : � strument was acknowledged before me this
day , 2 COS , «�< <. ♦' ' day of , 20 , by
who is perso ally kno t me or who has produced /L ��/ who is personally known to me or who has produced
�-� � �' as identification and who did take an oath.
�o -
identification and who did take an oath.
NOTARY PUBLIC:
�
mmission
p ires: M
Atlantic Bo
423870
,1 08
emission Expires:
•
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Plans Examiner
Engineer
Zoning