The URL can be used to link to this page

BP-05-1050BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Owner's Name (Fee Simple Titleholder) Contractor's Company Name Contractor's Address Job Address (where the work is being done) State Certificate or Registration No. Architect/Engineer's Name (if applicable) $ Value of Work For this Permit Type of Work: ❑Addition Describe Work: Notary $ 5• CV Scanning $ • Code Enforcement $ Total Fee Now Due $ (Continued on opposite side) 2-S4 .8c) Miami Shores Vill Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Owner's Address 1 .,S o , � City 14t 4Wi 1 , State I" Lam le.1014 Zip 3 '1 3 7 Tenant/Lessee Name Phone # C: City Miami Shores Village County Miami -Dade Zip 3'" 1 3 Is Building Historically Designated Y NO City • State 4 Qualifier GOo Electrical RECEIVED JUL ❑Alteration EINew Training/Education Fee $ O • 2.0 Radon $ Zoning Structural Plan Review. $ Plumbing / �� "4E3 Permit NoS — 1 Oa : aster Permit No. Phone # 7% -40 — 1 Phone # Zip e of Competency No. Phone # Mechankal Square Footage Of Work: ****************************F Submittal Fee $ Permit Fee $ S (/ %' Roofmg Repair/Replace ['Demolition CCF $ • 4 CO /CC Technology Fee $ ‘.' • C"© Bond $ 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 th bulii'ding permit is issued. In the absence of such posted notice, the inspection will not be approve and a reinspection fee will be c "ed. / , j♦ ? - Signattire Signatu Owner or Agent Contractor The foregoing 1 trument was acknowledged before pie this " ' g g g �� The foregoing,mstr�iihent was acknowledged before me this y ay.'.) 20 DS by l hl'Y� 5C l �� day of s , , �! day of ��:� >�;2� ,by who is personally known to me or who has produced j# s identification and who did take an oath. NOTARY PUBLIC Sign: ! � Print: ` My Commission xpires: e � • - V rh * * * * * * * * * * * * ** . * * * * ** * ** v�* * * *u� *************,********,**********,** * * * * * * * * * * * * * * *** * * * * * * * * * * * * ** ****************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: Chc 05/13/03 who is personally knot/ or who has produced as as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: * * * * * * * * * * * * * ** * * * ** My Commission Expires: **** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** / D 5 Plans Examiner Engineer Zoning