311 NE 94 St (6)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
10050 N.E. 2nd Avenue • Miami Shores, Florida 33138 • Phone: 305- 795 -2204 • Fax: 305- 756 -8972
Date L 03Job Address 3 9t' s Tax Folio
33J 343
Legal Description n l �� C p, 1 Historically Designated: Y No
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Owner /Lessee/Tenet lv A4 rw1"7H :1�' -7 t`� Master Permit # �OO
Owner's Address / 1 v ri sr: 3(6 Phone �l� 5
Addre,`s(
Contracting Co.
Qualifier
State # rl •
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Permit Type (circle one):
WORK DESCRIPTION: i \ (S7A c
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e`vty Commission DD150048
ores November 15, 2008
ROVE
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Zoning I
1 64, �� /. . 1'J Plumbing
Mechanical
SS# Phone
Municipal # Competency # Ins. Co.
IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY,
THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS 550.00 AND MUST BE PAID IN ADVANCE
BEFORE CALLING FOR ANOTHER INSPECTION.
ROVED: — o n Prn r"441 t �
Building
ELECTRICAL PLUMBING MECHANICAL ROOFING
Estimated Cost (value) �� 7 0 U
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN
YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR ANY ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). 1 certify that
all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required
for all disciplines.
OWNERS 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. Furthermore, I authorize the above named contractor to do the work stated.
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/M Y Com
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ture of Contractor or Owner Build r
Nancy Iglesias
•�'_ CommissjOf # DD117024
:9 � .f` o ° Ex P May 13, 2006
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340 Ele
Structural Engineer
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4 EES: PERMIT y RADON C.C.F � '0 0 NOTARY D C.)
Date
actor or Owner Builder Date
Expires
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•
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BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical
Miami Shores Village
Building Department
Owner's Name (Fee Simple Titleholder) Phone #
Owner's Address
City State Zip
Tenant/Lessee Name Phone #
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name Phone #
Contractor's Address
City State
Qualifier
Architect/Engineer's Name (if applicable) : Phone #
Architect/Engineer's Address
City State Zip
$ Value of Work For this Permit
Number of: Bays Stories Families
Type of Work: ❑Addition ❑Alteration ❑New
Describe Work:
County Escrow Fee $
Education/Training Fee $
* * * * * * * * * * * * * * * * * * * * * * * * * ** *Fee Calculation -Misc Permits * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Minus Plans Check Fee $ g B0
P4 t 3
7120
Permit Fee $
Tech $
Code Enforcement $ Bond $ 00
Plumbing Mechanical Roofing
Q5
,o - o
mo. ba
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No. / p 03 - L7o q
Master Permit No.
Zip
Square Footage Of Work: , 05
Bedrooms Baths
❑ Repair/Replace ❑ Demolition
Notary $ 5
Scanning $ dit Radon $ 2_ S
Struct. $_ ' T 1 °S Q't
(Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding Company's Address
3ity 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 Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of , 20 _, by , day of . - , 20 , by ,
who is personally 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.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
My Commission Expires: My Commission Expires:
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
ss******** s* s* s*s s***************.***********...********.******************** * * * * * * * * * ** * *s * * * ** * * * *s ** * *s
APPLICATION APPROVED BY: Plans Examiner
• Zoning
chc6/1 8/03