1205 NE 95 St (11)Contractor's Company Name
(Continued on opposite side)
Miami Shores Village
BUILDING
PERMIT APPLICATION
FBC 2001
$ Value of Work For this Permit
Total Fee Now Due $
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit Type (circle)
Owner's Name (Fee Simple Titleholder)
Job Address (where the work is being done) / 5:0_5
Permit No. iJ f� 2009) -t ' `- 3
Master Permit No.
Electrical Plu bing Mechanical Roofing
1 .- ) 4 1i N. ( Phone #
�, r
Owner's Address _
City AI?. / , .5 fixe State % Zip 1
Tenant/Lessee Name Phone #
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO ■
G L- ' »i P/C(.. Phone #
Contractor's Address
City State Zip
Qualifier
Architect/Engineer's Name (if applicable) Phone #
Square Footage Of Work:
Type of Work: DAddition / DAlteration ❑New ,� 7 Repair/Replace ❑ Demolition
Describe Work: /G G1L- Dpi GJ - �- �r 1► v v f f
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
5 - #
Submittal Fee $ �` (�., Permit Fee $ /00 --"' CCF $
O A 00
Notary $ •O Training/Education Fee $ 0, 0 Technology Fee $ 2' go
Scanning $ Radon $ Bond $
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature /E'/ -(A n, C d,-e- e Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this 2 -`1 The foregoing instrument was acknowledged before me this
day of RDNI , 2003, by 11 1.e rs MOQ L 1 , day of , 20 _, by
who is personally known to me or who has produced kl t pn sYCrL who is personally known to me or who has produced
r 0 As identification and who did take an oath. as identification and who did take an oath.
Anga Beck
N• ARY 'UBLIC:
s of
Si ` �.
Print: [':s7 su
My Conunission Expires:
************************************************** 1k************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
State Certificate or Registration No.
*********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** :.sue ****************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc 10/14/03
NOTARY PUBLIC:
Sign:
Print:
(Certificate of Competency Holder)
My Commission Expires:
Certificate of Competency No.
_ 4 " NOV 2 6 2
Plans Examiner
Engineer
Zoning
'p2tvt=�yP,`
- ` -S,F •.-
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= :3.ATE2 o_$.
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Miami Shores Village
10050 NE 2nd Avenue
Phone: 305- 795 -2204 Permit Number: BP2003 -1843
Printed: 12 /2/2003
Applicant: JAQULYN
Owner: NOELL
JOB ADDRESS: 1205 NE 95
Contractor
Local Phone:
Parcel # 1132060143970
Building Permit
NOELL
JAQULYN
ST
Contractor's Address:
Legal Description: 5 - 6 53 42 MIAMI SHORES SEC 3 PB 10 - 37 LOT 21 & 22 BLK 84 LOT SIZE
Fees: Description Amount
FEE2003 -7581 Building Fee $100.00
FEE2003 -7582 CCF $0.60
FEE2003 -7583 Notary Fee $5.00
FEE2003 -7584 Training and Education Fee $0.20
FEE2003 -7585 Technology Fee $2.50
FEE2003 -7586 Scanning Fee $3.00
Total Fees: $111.30
Total Fees: $114,.30
Total Receipts: .9 c
Permit Status: APPROVED Permit Expiration: 5/22/2004 Construction Value: $600.00
Work: REPLACE AWNINGS
Signed: (INSPECTOR)
Page 1 of 1
56 36 C_ Q__
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: