530 NE 96 St (13)I
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle):
Owner's Name (Fee Simple Titleholder) Phone # ? Y1/ Zj ZZ1' cr /
Owner's Address Z 30 /tie //02.. h 5*. mss` 75 h'
City 1'IA.; a.hs S1 ...3 State "L • Zip 33 /3e
Tenant/Lessee Name
Job Address (where the work is being done) .5 34: APC • / s7""
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO
Contractor's Company Name '�/ e L A�✓ST�✓ �--? - /
Contractor's Address 4 ,6300 / / .cf.r.6
City / 4714 I State /
= -cp0 /n/ .'
Qualifier
Architect/Engineer's Name (if applicable) Phone #
e of
$ Vadue of Woit ro ~ S' Square Footage Of Work: 3/ 94'S $T
t
Typie of:Work "Q1Alldition >;' Iteration ew ❑ Repair/Replace ❑ Demolition
Descniie arr •r1.•+ /) E'44) awSr7tuGP1e/V r,4■! / lli9r i.e
Submittal Fee $ Roo
Notary $
Scanning $
Code Enforcement $
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * *I*
Training/Education Feee$
Radon $ 3 q,
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
Building Department RECEIVED
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 JU ' 7 20n
Tel: (305) 795.2204 Fax: (305) 756.8972
Electrical Plumbing Mechanical Roofing
Structural Plan Review. $
Permit No.
Master Permit No.
Phone #
Phone #
Zip
Zip 33l6
7640 23, 204/
7a - -21 0
Permit Fee $ 7 / p .� CCF $ CO /CC I50- 940
� Technology Fee $ /b'. e3
Zoning /00 '— Bond $ 300—
Bonding Company'r Ja le (if applicable)
Bonding CompanY's Address
City State Zip
Mortgage Lendeir's Name (if applicable)
Address
Mortgage Lender
City
Application is hekeby 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
II 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 TQ 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 WIITH 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 t - absence of such posted notice, the
inspection will n r t be . pproved and a reinspectiojyfee will be charged.
T
day
wh
NOT
Sign:
Print:
Owner or Agent fi vat ...„04eract: O .1.,,c, oin instrument was ac . o wled ed before me s �� � 3
re
going g g the �} (� The foregoing instrument was acknowledged efore me this Neof
/
206 , iL . O it • , day of
My Commission) Expires:
known to me or who has produced
As identification
My Commission Expires: — //—
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
APPLICATION
Chc 12/15/03
APPROVED BY:
State Zip
id take an oath.
Signature
who is
NOTARY PUBL
Sign:
Print:
C
200 by OJAGl../(11 /)E Z ,
Plans Examiner
Engineer
Zoning
Miami Shores Village
4/ C. ' Building Department
�_, ?OM Tel: N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle
City ,Skc fio State
City
Contractor's Company Name
Contractor's Address
*- «a
Submittal Fee $2.0 O
Total Fee Now Due $
(Continued on opposite side)
Electrical
Owner's Name (Fee Simple Titlehol
Owner's Address ✓ !� E ,/
ID)y—
FcFc-
-
Tenant/Le Name Phone #
Is Building Historically Designated YES NO
$ Value of Work For this Permit
Plumbing
Type of Work: ❑ Addition ❑Alteration New
(_
Describe Work: L� N � mil° mac- v -"A DY1
Permit No.
Master Permit No,.) U 0 L (
Miami Shores Village County Miami -Dade Zip 33 tag
Mechanical Roofing
C Phone # 7 1 - 5 / - 7 3 G 3c '/
,( 30S- 'S
zip 3 r 3 8
Job Address (where the work is being done) ✓ S�' 3 O 1v C ' b 5f
Phone #
City State Zip
Qualifier
Architect/Engineer's Name (if applicable) hone # t
Square Foo age Of Work
* * * * * * * * * * * * * * * * * * * * * * * * * */ s * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Or 411
❑ Repair/Replace ❑ Demolition
Permit Fee $ CCF $ CO /CC
Notary .9LS _'p ) Training/Education Fee $ Technology Fee $
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $S?). 0c) `>< 62) 'dm f' 5 = - . 617
Bonding Company'SVgme..if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender'$ Name (if applicable)
Mortgage Lender's!Address
City j 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 thi$ 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 TOIOWNER: 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
COMMENCEM NT."
Notice to Applicait: 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 isi 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
Owner or Agent
The f regoing instrument was a
210,
who is personaly
NOT
Sign:
Print: aq&
My Commission Expires:
Chc 12/15/03
^ir PJ:
APPLICATIOI4 APPROVED BY:
owledged before me this
(Certificate of Competency Holder)
State Certificat I or Registration No. Certificate of Competency No.
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of , 20 _ , by
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:
Sign:
Print:
My Commission Expires:
* * * * * * * * * * ** **************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
V? C A a- 5 / Plans Examiner
Engineer
� l oY
� Zoning