477 NE 92 St (14)BUILDING ;' Permit No. S7C) S - 3 ) 6z
Owner's Address
Owner's Name (FeeAujple Titleholder)
State
.lob Address (where the work is being done)
City _ _ Miami Shores Village
is Building historically Designated YES
Architect /Engineer's Name (if applicable)
Value of Work For this Permit
c; (11 1) L n k�
Code Enforcement $
Total Fee Now Due 5 `� �•='
(Continued On opposite side)
1(,
lvllaml mores v iiiage
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
PERMIT APPLICATION / ,.,� 1Vlaster No. 90.3 -1i 0
FBC 2001 ., ,, u
Permit Type (circle): ( Electric2C1- -.PI n'ngVlechanical Roofing
� car
1 a o `s�
City
- 7fl, Cti' y
Tenant /Lessee Name Phone #
Kb
County Miami -Dade Zip a 3
Zip
Contractor's Company Name L' �k- i'�' t Phone
('onlractor's Address
('il }• State_ Zip
(Qualifier
State Certificate or Registration No. Certificate of Competency No.
Square Footage Of Work:
Type of Work: ❑Addition ❑Alteration [(New ❑ Repair/Replace
Describe Work: �t, 1C_ to r rL ►�
Structural Plan Review. $ ---
Phone #
Oh pi ,vV11 Y L
(. — * * * * * * * * * * * * * * * * * * * * * * * * * * * *F es * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
sync6,11±1
❑ Demolition
5F
Snhmittal Fee 5 C• 0C- Permit Fee $ 3(2 CCF 5 /, a 0 CO /CC
Notary 5 Training/Education Fee $ £ . q t) Technology Fee $ 2 5
Scanning 5 G1 `" Radon $ Zoning 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 o/'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 he posted al the job site
for the first inspection w ich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection w'ij not be ap ved and a reinspection I e will be charged.
Signatur
Chc 05/13/03
1
Signature
Owner or Agent Contractor
The foreg g instrument was acknowledged before me this t The foregoing instrument was acknowledged before me this
day of .5 � , 21 \ . by E u U � I G �� I ■ G a of , 20 _, by
who is personally own t. me or who has produced
My Commission Expires:
who is personally known to me or who has produced
A identification and who did take an oath. as identification and who did take an oath.
maoei ° ,trgaS
NOTARY PUBLIC: / .�,� u , 4R4 NOTARY PUBLIC:
Commission -. "i. 2007
Sign: Sign:
q
Print: ; o' fl° ' t\..!af1 C Bo .c ina. t
Print:
My Commission Expires:
*** * * * * * * * * * * * * * * * * * * * * * * * * * * * - * *. *************************************** * * * * * * * * * * * * * * * * * * * * * * * ** ** * * **
APPLICATION APPROVED BY:
************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * *j' ******************** * * ** * * * * * * * * * * * * * * * * * ** **** * * **
MAR 2 5 203 Plans Examiner
Engineer
Zoning