1200 NE 97 St (5)Owner's Address /ZC'C /vie= C 6f.
Tenant/Lessee Name
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
TO (305) 795.2204 Fax: (305) 756.8972
BUILDING Permit No. Y
PERMIT APPLICATION ° Master Permit No.
FBC 2001
Permit Type (circle): uilding/ Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Title older) 01/21, C O 1 1Ywi Phone # (3 )
City tit:%s State I -L Zip 33 / 36"
Job Address (where the work is being done) /Za) A E 617,_57
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES
Contractor's Company Name (..J GL.; i (1' •
Contractor's Address
City
Qualifier
Architect/Engineer's Name (if applicable)
State
NO
Phone #
State Certificate or Registration No. Certificate of Competency No.
cc-4 , • C -/ )
Zip 3 ,3 %.3f.
Zip
Phone #
$ Value of Work For this Permit ' 6(0 Square Footage Of Work:
Type of Work: ['Addition Alteration ❑New ❑ Repair/Replace ❑ Demolition
Describe Work:
****************************F
** * * * * * * * * * * * * * * ** * ** ** * **
Submittal Fee $ Permit Fee $ / ;' CCF $ C . CO /CC
Notary S; • CO Training/Education Fee $ C) 2 Technology Fee $ 2 •
Scanning $ • CCD Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $ ` )
(Continued on opposite side)
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 //7.47.3 CW IVi-) Signature
Owner or Agent
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of l/ •1? 20 0 i, by )�����i\C1 l'_f1, C 1 C1yQ , 20 ,by
who is personally know e or who has produced ,.\ - (1 who is personally known to me or who has produced
ntification and who did take an oath. as identification and who did take an oath.
NOTARY P NOTARY PUBLIC:
Sign: T , � z , Si n:
:-: ma c; 4f1t11 g
Print: TM' .:x', U i.i:, / 7 7 Print:
tti ! ll'
Itip ;rF riinr *'r My Commission Expires:
******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *ir ************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
chc 05/13/03
My Commissioh.Expires:
APPLICATION APPROVED BY:
Contractor
Plans Examiner
Engineer
Zoning
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 9/22/2005
Applicant: MARIA
Owner: CONTRERAS
JOB ADDRESS: 1200
Contractor
Local Phone:
Parcel # 1132050090620
NE 97
Signed: (INSPECTOR)
Signed: (Contractor or Builder)
Building Permit
Permit Number: BP2005 -1384
CONTRERAS
MARIA
ST
Contractor's Address:
Legal Description: EARLETON SHORES PB 43 -80 W12.50FT OF LOT 20 & ALL OF LOT 21
Permit Status: APPROVED Permit Expiration: 3/21/2006 Construction Value: $500.00
Work: CHANGE FIXTURES IN BATHROOM
Fees:
FEE2005 -12719
FEE2005 -12720
FEE2005 -12721
FEE2005 -12722
FEE2005 -12723
FEE2005 -12724
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: $111.30
Total Receipts: $0.00
BY:
Page 1 of 1
c 0 5 MD
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.
7 . �,.