520 NE 92 St (16)BU
PE I:V1.11 Jl £ -. s --- - -
FBC 2001
Permit Type (circle): Building Electilcai Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder)
Owner's Address
City State Zip
Tenant/Lessee Name Phone #
Job Address (where the work is being done)
City Miami Shores Village County Miat i -Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name . `",
Contractor's (:_
City Ir . /¢,y,/ State /
Qualifier i J e 3ie fl7 //A " /6 -R .zz_
Architect/Engineer's Name (if applicable)
Type of Work:
Describe Work:
❑Addition
Submittal Fee
Notary $
Scanning $ Radon $
Code Enforcement $
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
ig Department
75-z
State Certificate or Registration No. t!'r e?d- -q 9,;
$ Value of Work For this Permit $
Alteration
Training/Education Fee $ 0'
enue, Miami Shores, Florida 33138
)5.2204 Fax: (305) 756.8972
Il Rgi 3
come,
❑New
Structural Plan Review. $
Permit No.
Master Permit No.
Phone #
Phone # 3c7
( 2 / 1 6; .
Zip 33(.5:5
Certificate of Competency No.
Phone #
Square Footage Of Work:
/4
❑ Repair/Replace
T
005-P7
eft75 cat./
❑ Demolition
9
* * * * * * * * * * * * * ** * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
`j— Permit Fee $ 0
CCF $ t9 • CO v CO /CC
Technology Fee $ 5. l03
Zoning Bond $
1/ 117/7
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 properly 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 abs: ►' e of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
Owner or Agent
The foregoing instrument was acknowledged before me this The fo,i_ instrument was ac
day of , 20 _ , by , day •41,,,44...;
who is personally known to me or who has produced who is personally own ep
n to mr
As identification and who did take an oath.
NOTARY PUBLIC:
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc 05/13/03
•
_' • :► rctor
20 by
•
• gpd before lie this
7 /
• 7 produced
w to did take an oath.
c : F**** ***
100 4.44. /
°
Ex i re ::— IIi:rZ���r
p s: ay , I
I Z1 iW1nisn Expires:
Atlantic Bonding Co In
5
/L /'��A'5 Plans Examiner
Engineer
Zoning
*
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 2/8/2005
Applicant: LUCRECIA ADAMS
Owner: ADAMS LUCRECIA
JOB ADDRESS: 520 NE 92 ST
Contractor LIGHTS ON ELECTRIC
Local Phone: 954 392 - 6628
Parcel # 1132060141190
Fees: Description Amount
FEE2005 -1642 Building Fee $225.00
FEE2005 -1643 CCF $0.60
FEE2005 -1644 Notary Fee $5.00
FEE2005 -1645 Training and Education Fee $0.20
FEE2005 -1646 Technology Fee $5.63
FEE2005 -1647 Submittal Fee ($50.00)
Total Fees: $186.43
Total Fees: $186.43
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 7/10/2005 Construction Value: $1,000.00
Work: ELECTRIC HOOK UP FOR POOL AS PER PLANS- MASTER PERMIT BP2005 -24
Signed: (INSPECTOR)
Electrical Permit
Permit Number: EL2005 -17
Contractor's Address: 10181 N. W. 21 ST.
Page 1 of 1
Legal Description: MIAMI SHORES SEC 2 PB 10 -37 LOT 4 & 5 BLK 58 LOT SIZE 100.000 X
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: