BP-05-242BUILDING
PERMIT APPLICATION .
FOC 2001
Permit Type (circle):
State Certificate or Registration No.
Owner's Name (Fee Simple Titleholder) '171:N 15J i1S _Phone #�a; • •
Owner's Address 2 ' S Lt X 3) 1'
City 'N1 11 State
'Tenant /Lessee Name
Job Address (where the work is being done) �� S""]-
City Miami Shores Village Couhty Miami -D. de
Is Building .Historically Designated YES
Contractor's Company Name &
Contractor's Address
City - Slate_
Qualifier
Architect/Engineer's Name (if applicable) .44-14+ ' 6'lvt.,4 ) Ae Phone #
5 Value or Work For this Permit* l0: , v
Electrical
NO
Type of Work: giAddition ]Alteration :New
El Repair/Replace D Demolition
Describe Work: r long "' repit.Arr Bv► -- 1 pr . ' LI QA.) !
* ** * **********************Fees************ * * *** ***k********* ****
Submittal Fee $ Permit Fee $ - CCF $ A‘CP CO /CC
Notary 5 Training/Education Fee $ 4 A-0 Technology Fee $ 05
Scanning $ Radon $ Zoning — Bond $
Code Enforcement $ Structural Plan Review. 5 -
Total Fee Now Due 5 J 1 T
(Continued on opposite side)
1 A. t.... N•1111 N1.iV 1 V►J ♦ LL.L .� - o�6d
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 es( t ! 08—
Tel: (305.. 79 _ t ! :972 �•
F :`. `° 2 r. No. j PQ 5
Master Perinit No.
maw CM
Plumbing
Zip 3 l S AS
Phone #
Phone #
Certificate of Coifrp icy,
Mechanical Roofing
Zip S3) 35
Square Footage Of Work: ,
r
S
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 . and a rei, tionfee,will be charged.
Signature ` F .' /2 it
Owner or Agent
The for 'n instrument was 3acknowledged 1 ep fore me
da of 2 S b J
who is personally known to me or who has produced � Q
NOTARY P
Sign:
Print:
My Commission Expires:
* * * * * * * ** * * * * * * * * * * * * * **
Cho 05/13/03
As identification and who did take an oath.'
, Contractor
q 'The foregoing instrument was acknowledged before me this
ay 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:
s
% _ Commission DD231984
Expires: Jul 1 007
e "omi., 110tided't My Commission Expires:
° ,lki nticBondin Co Ins
******************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * ** *** 4 * * * * * * * * * ** * * * **: * * * * * * * **
APPLICATION APPROVED BY: Plans Examiner
Engineer
Zoning
g od -�* y� ° s