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BP2003-1164Tenant/Lessee Name BUILDING PERMIT APPLICATION FBC 2001 Miami Shores Village Build' p_w :rent Permit Type (circle): Building Electrical Plumbing ,echanical Owner's Name (Fee Simple Titleholder)' Gtl �� -'t; Ct1 t C,,t) I�" " I Phone # Owner's Address L: e ' L c r2... City 1 } ' 1 (4 S State � - Job Address (where the work is being done) (t C ' Kt E c J./2_ 3 City Miami Shores Village County Miami -Dade Zip i 3 `7 Is Building Historically Designated YES NO 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. 13P — Master Permit No. Roofing Zip ;3 ' 3 i Phone # 4'1 3- -3016 Si Contractor's Company Name Phone # Contractor's Address City State Zip Qualifier Architect/Engineer's Name (if applicable) . Phone # Architect/Engineer's Address City State Zip $ Value of Work For this Permitr Q-- i Square Footage Of Work: Number of: Bays Stories Families Bedrooms Baths Type of Work: ['Addition ['Alteration ['New ❑ Repair/Replace ❑ Demolition Describe Work � in_;°" I? l S. (,. - d V' i I. e-° t....,--:e' .. l --(Lie vlA C' V r. '( 0 c: C` * * * * * * * * * * * * * * * * * * * * * * * * * * * *F es * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** County Escrow Fee $ y Permit Fee $ ! Notary $, l Education/Training Fee $ Tech $ Scanning $ Radon $ Code Enforcement $' Bond $ 3 'D 0 -' Struct. $ Minus Plans Check Fee $ Total Fee Now Due $ 3 4 G . L? 0 h 5oLo (Continued on opposite side) 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 no . - approved and a reinspection fee will be charged. / '� Signature � Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this (\ The foregoing instrument was acknowledged before me this day of , 20 03, by Qb \O t-Q 1 Con , day of - , 20 _, by who is • - rsona ly known to me or who has produced who is personally known to me or who has produced As identification and' who did take an oath. as identification and who did take an oath. NO ' ARY P : LIC: `� ^ � � Si. s: /. / f I _ !' /_ • J, Sign: Print: J `..lr� IN ,. �,� .. Print: • My Commission Expires: Expires November 15; 2006 My Commission Expires: ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. *********************************************,***** s************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ** APPLICATION APPROVED BY: Chc7/7 /03 (t(� 7 lr10 o3 Plans Examiner Engineer Zoning , MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date r1 Time Type Insp'n n () f V •,� Permit No. 69 ,2,11— d� Name FQ\ Cb0 Address 1 NE, Company Phone # 3-,0 543 - 3o Y • For Inspector: 3P Name & Date Approved Correction Re- Insp'n Fee ❑ (5r1 Date Typelnsp'n F Permit No. t5P 00( 1 1(04 Correction Re- Insp'n Fee MIAMI SHORES VILLAGE i() BUILDING DEPARTMENT r 305- 795 -2204 Building Inspection Request /?//f h, v Time Name Falcon Address 100 NE. q 2 ST Compan O w 1 Eij. Phone # 1 For Inspector: 1 2,110LI Name & Date Approved ❑ AlKe MIAMI SHORES VILLAGE BUILDING DEPARTMENT C Y\ 305- 795 -2204 \L.J Building Inspection Request Date ©2, \ , O 5 Type Insp'n Ft/ 4LUAZCOC Name y /� ry Address (/ ( q 5T Company Phone # Inspection Date Permit No. Approved Correction Re- Insp'n Fee ❑ Date Type Insp'n Permit No Name Address / 0 0 / . e . C c�,_,,C1 > CompanyCnik pp�� // Phone # 7? �j J 3 0 6 For Inspector: is/oiR Name & Date Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 B ilding Inspection Request Ti.e Z003-- MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Bui)ding Inspection Request Dates Type lnsp'n /� VrLeW Permit No. e2f ) i o- Nam 1 /C( C\ Address ! Company `r Phone # Inspection Date Approved Correction Re- Insp'n Fee ) ran J.s ( d svcieedics AAgd L , ct5 MIAMI SHORES VILLAG D Type Insp'n BUILDING DEPARTMENT 305- 795 -2204 Bui ding Inspection Request A Permit • • A • r 00 Na Address Company q Phone # 3 O� - 7 S 6- (o 0 6 Inspection Date ._S Approved Correction