1084 NE 97 St (12)BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical P9umbing (Mechanical Roofing
Owner's Name (Fee Simple Titleholder), Y Phone #
a� 7
Owner's Address )
City YY1 t, V Y tate
Tenant/Lessee Name
Job Address (where the work is being done) \C M t / t- .
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES
Contractor's Company Name C . j
Contractor's Address /7. ,/ :
Cite 0 -
Qualifier r2. 1 1
State Certificate or Registration No.
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
State
Submittal Fee S Permit Fee $
Notary S Training/Education Fee $
Scanning S Radon $
NO
Permit No.
Master Permit No. `j `n-f,,
Zip `
Phone #
Phone #
Zip
Code Enforcement $ Structural Plan Review. $
Phone #
Zip
L -�
if
Certificate Of Competency No.
Square Footage Of Work:
Type of Work: ❑Addition ❑Alteration ['New ❑ Repair/Replace ❑ Demolition
Describe Work: E:%e C'
:.. 4 :y y. - �; ,i t/ 1 c
CCF
Technology Fee $
Zoning Bond $
CO /CC
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
J
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 gn V �f�( -.� r Si
Owner or Agent
Contractor
The foregoing instrument was acknowledged before me this ;, ; a� 1The foregoing instrument was acknowledged before me th /=)—•
day of , ") , 24./); , by , day of -- , 20 Y. by d 1:— _fiv /7 ,
who is personally known to me or who has produced who is personally known to me or who has produced
s
As identificatiorprld who did take an oath.
NOTARY
Sign:
Print:
My Commission E
Chc 05/13/03
a
2'08
Borded through 1st State Insurance
*********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
NOTARY PUBLICS
Sign:
Print:
Ann�t
My Commission Expires:
7 " l j
o did take an oath.
•ssette Corbera
E Co mission # DD217755
pigs -4one 1, 2007
Aar66n Notary
1- 800 - 350 -5161
********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
******************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** . * k * * * * * * * * * * * * * * * * * * * *4* * * * * * ** * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 2/15/2005
Applicant: AZUCENA
Owner: ESPINOSA
JOB ADDRESS: 1084 NE 97
Contractor RESULTS AIR CONDITIONING CO Contractor's Address: 7 •1 NW 72
Local Phone:
Parcel # 1132050170190 Legal Description REV P . MIAMI SHOES SE 8
Fees: Description
FEE2005 -1977 : r•:ding Fee
FEE2005 -1978 CCF
FEE2005 -1979 Technolo: wee
FEE2005 -1980 Training and cation Fee
FEE2005 -1981 Scanning Fee
Total Fees:
do
Permit Status: APPROVED Permit Expiration: 7/18/2005 Const
Work: INSTALL 2 TON SPLIT NC WITH DUCTWORK AND BATHROOM V TILATION- MASTER BP03 -1280
Signed: (INSPECTOR)
Mechanical Permit
Permit Number: MC2005 -10
ESPINOSA
AZUCENA
ST
Amount
4 175.00
$1.80
.38
$3.00
$184.78
Value: $2,810.00
Page 1 of 1
43 -51 LOT 7 BLK 181 LOT
Total Fees: $184.78
Total Receipts: $0.00
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: