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657 NE 92 St (12)IR ECE ii N� 3 2004 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): $ Value of Work For this Permit Building Architect/Engineer's Name (if applicable) Miami Shores Village Building Department Owner's Name (Fee Simp • . - o der) Owner's Address (0 73 N 6 9)'• -4 P[ 7 r Electrical Plumbing Mechanical Roofing 3 Ei-) A /2 Phone # 305 - /5 . 7 City PI 111 hl 1 5 I C 1k. s State T L Zip 3 3/ 3 g Tenant/Lessee Name Phone # Job Address (where the work is being done) (13 (V c 97 S f rE c f fir 1 7/- City Miami Shores Village County Miami -Dade Zip 3 3/ d' Is Building Historically Designated YES NO t/ Contractor's Company Name l ' Phone # Contractor's Address City State Zip Qualifier State Certificate or Registration No. Certificate of Competency No. V Total Fee Now Due $ (Continued on opposite side) Permit Noel' C' C Master Permit No. Phone # Square Footage Of Work:! S Q I`- T Type of Work: ['Addition ;•., : 4 ;, ['New ❑ Repair/Replace Demolition Describe Work: L5 CE 0.4G 13A c - 1 of In1 Gam\ \ 19f ' ee i C e I n l g coo V►'t Submittal Fee $ SC % C C: Permit Fee $ CCF $ t 0 CO /CC '-- Notary $ Training/Education Fee $ • Z0 Technology Fee $ Scanning $ 3 - Radon $ Zoning Bond $ * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Code Enforcement $ Structural Plan Review. $ 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 not be approved and a reinspection fee will be charged. Signature 1 Owner or Agent The foregoing instrument was ackn d before me this 50 day of who is ersonally known to me or who has produced •-1- ,,. * * * * * * * * * ** Jul 13,2007 NOTARY ".'4 "'��, n Mabel Vargas ,;; Sign: �� ' '� I bik � � : 1 1 Print: SA � �A " ' �� �arnie Boling Co. , tie. My Commission Expires: 201f, by * * * * * * * * * * * * * * * * * * * * ** ************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: Chc 05/13/03 ›LIA. /4/A As identification and who did take an oath. Signature Contractor • The foregoing instrument was acknowledged before me this day of , 20 by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: it ***************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *... ************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** JUL - 1 2004 Plans Examiner Engineer Zoning 4 OWNER BUILDER DISCLOSURE .STATEMENT I E F'} T R 1 Z S i L A- S being the legal property owner, for the property X Located at: X 7 3 N E 9 a 4- Op - 7- 14 ( ( s fte)Z E 5 3303 Legally described as - Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S. 489.103(7),And I have read and understand the following disclosure Statement, which entitles me to alvork as my own contractor, I further understand that I as the owner must appear in person to complete all applications. State law requires construction to be done by licensed contractors. You have applied for a permit under an exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two-family residence or a farm out - building. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is completed, the law will presume that you built it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as your contractor. It is your responsibility to make sure that people employed by you have licenses required by state law and by county or municipal Iicensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A. and with- holding tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, building codes and zoning regulations. Proof of ownership provided ( ) Was ac owledged before By � — /P 2 Produced VILLAGE OF MIAMI SHORES Owner BUILDING DEPARTMENT DISCLOSURE STATEMENT initial of reviewing clerk. The foregoing instrument day of V , 20 CL--\ I ) who is personally kno • to me or who has • as identificati • who did take an oath. Notary t (4 t' AIL - ro De RE 1ovGp C l 12) i ii s Dv0 P. Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 7/6/2004 Applicant: LOURDES Owner: JENKINS JOB ADDRESS: 673 Contractor Local Phone: Parcel # 1132060430250 NE 92 ST Signed: (INSPECTOR) Signed: (Contractor or Builder) Building Permit Permit Number: BP2004 -898 JENKINS LOURDES 7F Contractor's Address: Legal Description: SHORES PLAZA WEST CONDO UNIT 7F -2ND FLOOR BLDG 2 UNDIV .03387% INT Fees: FEE2004 -6711 FEE2004 -6712 FEE2004 -6713 FEE2004 -6715 FEE2004 -6716 FEE2004 -6717 Description Building Fee CCF Notary Fee Training and Education Fee Technology Fee Scanning Fee Total Fees: Amount $100.00 $0.60 $5.00 $0.20 $2.50 $3.00 $111.30 Total Fees: $111639 O Total Receipts: 0.00 6 I, 3 0 Permit Status: APPLIED Permit Expiration: 12/27/2004 Construction Value: $150.00 Work: REMOVAL OF WALL IN KIT BY: Page 1 of 1 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 1 assume responisibility for all work done by either myself, my agent, servants or employes.