BP-05-1572BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle):
Owner's Name (Fee Simple Titleholder) A- id e / i6 Ffoos./' Phone # (,0 6d - Agee
Owner's Address mei /1/g 96 sae r
City //I'd Hi #a e V; 14C State ri 0 e
Tenant/Lessee Name
Job Address (where the work is being done) IZ 87 A/ 6 96 51 e E E
City Miami Shores Village
Is Building Historically Designated YES
S-rAT7_-
Contractor's Company Name C4 frA
Contractor's Address J 2 a /v .
City /1/4 .; State
Qualifier eca y
State Certificate or Registration No. CGC 0 V/ (.?
$ Vaue of Work For this Permit
Describe Work:
Scanning $ (X)
Code Enforcement $
Total Fee Now Due 3 1 1 - 1 0
(Continued on opposite side)
Building
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: 305 972
A/A
/
RE ED ED
NOV 9 1 305
of Mas
"A)
Do ( Decet-
Electrical Plumbing Mechanical
County Miami-Dade Zip .Z.? /
NO
r/pv(
\AN.
P. C.-or \ sl CZ)
- Phone # 7e c - Z /0 -
Certific
Architect/Engineer's Name (if applicable) t- tx/v2)6e,s g
ripe of Work: -0Additfon ['Alteration ONew
Zip /de
Phone #
Permit S. ISPO5 1512_
er Permit No.
petency No.
Square Footage Of Work:
Roofing
9
R22- 93s
****************************F
Submittal Fee $ Permit Fee $ CCF $ 4.80 CO/CC
Notary $ Training/Education Fee $ 1 - bCD Technology Fee $ -10
El Repair/Replace .L.: D Demolition
• /
Radon $ Zoning Bond $
Structural Plan Review. $ 5
REG 031 112205 1147 MCE 032030 CHAFGE
$.311.10
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
3�c Mortgage Lender's Name (if applicable) ' T 1 O u4 • to
0`
Mortgage Lender's Address S Leo Co ripe to C•
cit Fre al a cn c k state
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 A}FIDAVIT: 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
promise 47 good faith that a copy of the notice of commencement and construction lien law brochure will
whose property is subject to attachment. Also, a certed copy of the recorded notice of commencement
for the fir inspection which occurs seven (7) days after the building permit is is d In the
inspection will not be approved and a reinspection fee will be charged
Signature
Owner or Agent
The foregoing instrument was acknowledged,befo,'; e this 8
day of tVO0 ,20dS,by Cior4tS r34` o45
who is personally known to me or who has produced
l A
identification cation and who did take an oath.
Sign:
Print
My;
* **
NOTARY
i 4;
BONDED THROUGH
ADVANTAGE NOTARY
APPLICATION APPROVED BY:
Chc 05/13/03
r..
Ai
IY1.64.1•1 \ o► wc�.
Sign
Print:
My Co
****************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Zip ZIA.
$2500, the applicant must
be delivered to the person
be posted at the job site
f such posted notice, the
Signature /;.
T * t . ctor
The foregoing ins a ent was'<�cle vledged before me this S'
I'
day of JO ,20 DS , by i Y44, Si era',
who is personally known to me or who has produced
identification dentification and who did take an oath.
1l /8' A7 S 5 Plans Examiner
Engineer
Zoning
PERMIT # e( - (51
CONTRACTOR: CAMP IDENALS:::Prvir
SUBMITTAL DATE: IUCA/ ES 0 d(D:D
PROJECT TYPE: fL,V LA-)C00 oK
t% jii
ZONING NA*
toS
r .\2 :
FIRE
IMPACT FEES
/ ' / s / 5 204 ,
STRUCTURAL
ELECTRICAL
HRS /DERM
PLUMBING
NOC
MECHANICAL
DP
BLDG
1l1
, '
i
Miami Shores Village
me ct , 5c . Building Department
ICO 4 . ae PW
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle)
Owner's Name (Fee Simple Titleholder) 4-00 . 13/2..OP ie_y Phone # 305 754 01040
Owner's Address 1 87 114. 31 •
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
City M 1 AM l 51-) - 0 State F1,0 1 DA Zip 3 31 ,,e)
Tenant/Lessee Name
Describe Work:
Job Address (where the work is being done) 1 ZS7 " : y1.0 7 S r.
City Miami Shores Village County "; `` iami -Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's Address
City State
Qualifier
State Certificate or Registration No. Certificate of Co ncy No.
Architect/Engineer's Name (if applicable)
$; Value of Work For this Permit Square Footage Of Work:
Type of Work: ['Addition DAlteration
* * ** ** *** * * * * ** ** * ** * *** * * ** F ees * * ** **** * * ***** ** * * *** *** * * * **
Submittal Fee $ Permit Fee $ �� • CCF $ CO /CC
Notary $ Training/Education Fee $ Technology Fee $
Scanning $1/4 . CO Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $ _Do
(Continued on opposite side)
Phone #
Permit
Master Permit No.
Electrical Plumbing Mechanical Roofing
4 Zip
Phone #
❑ Repair/Replace
❑ Demolitio
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 ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT."
APPLICATION APPROVED BY:
chc 05/13/03
Notice to A p p l i c a n t : As a c o n d i t i o n to t h e i s s u a n c e of a buI ip ��. it} an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencementc� ' (lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recotde n on e of .ommencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permitH Luf,7,' e absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this
day 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:
My Commission Expires:
Signature
Contractor
The foregoing instrument was acknowledged before me this
day 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:
My Commission Expires:
ofr
Plans Examiner
Engineer
Zoning