639 NE 97 St (4)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date / D/ a o 6 T6 Job Address Ls 1 g q 7 Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant q ( c k * P S) € (J Master Permit #
Owner's Address iQ o� / /L/ t� 97 'Phone 4'
Contracting Co. /4
Qualifier ■.l erF (v U`P Ss# // Phone e76 - / a v
State # Cf Municipal # Competency # Ins. Co.
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILDING ELECTRICAL
WORK DESCRIPTION j s'��r�'v�
Square FL Estimated Cost (value) /0 Co • 0
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
of owner and/ r Condo President
0
Signat
'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
ating cons. i///. nin g. Furthermore, I authorize the above -named contractor to do the work stated.
7y�
Date
Notary as to Owner and/or Condo P esid; s'" Date
My Commission Expires_ - - - - - — - - -- - }
P0 OFFICIAL NOTARY SEA!. ]
O. DARTARA A{ff FOC:1, 7.7.1 ,!
COPULISSIOM iiSU«:6CF3 1�
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FEES: PERMIT £ 0,0 RADON C.C.F.
APPROVED:
Zoning Building
Mechanical Plumbing
S
Address
Address
Address
PLUMBING) MECHANICAL ROOFING PAVING FENCE SIGN
Address
traitor or
Electrical
C )'7 Azm
Notary as to Contractor or Owner - Builder -- Date
My Commissi9r, Expires : i ,, '
.. 9 � n n -, f C , � : u',L
1 , ,. � 7 a i i ' ! �� CA-;-.F.,. ,, s �
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NOTARY BOND
TOTAL DUE Sigrie
Engineering
_ Miami Shores Village
'F;''r�:� uv o Building Department
2 9 2323 g p
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) .. A4OrJ
e • 0/ /1 Phone 431)3d 757 — 392'2--
Owner's Address t 37 /Ve ' Sf
City pY)1 q +M/ . h<-) State Zip 35 /38
Tenant/Lessee Name !— Phone #
Job Address (where the work is being done)
Describe Work: 2et.14/ ° 69
Minus Plans Check Fee $
e.
,3? / 97
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO 1S
Contractor's Company Name 6c717/
Q 'tP 7 / K G /� �J ay +� 7 �' PV Lt�.S .l - /36d
J
Contractor's Address Ae /1�� / S
City 1 SI / / State Zip 334/
Qualifier 4f L ~� G�
State
- Phone #
Architect/Engineer's Name (if applicable)
Architect/Engineer's Address
City
• $ Value of Work For this Permit � Square Footage Of Work:
Zip
Number of: Bays Stories Families Bedrooms Baths
Type of Work: DAdditio DAlteratio� :New ❑ Repair/Replace ❑ Demolition
AREw�. i
460
County Escrow Fee $ (00 Permit Fee $
Education/Training Fee $ Tech $
Code Enforcement $ Bond $
Total Fee Now Due $ 6 5. 60
Permit No. trP ZOO'S I tO
Master Permit No.
Zip u /3 I'
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * ** * * * * * * * * * * * * * * * **
Notary $ 5 . CXJ
Radon $
Scanning $
Struct. $
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
(Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding Company's Address r//9-
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or A
The foregoing ins tr was acknowledged before me this
day of 20 03, by 73), c
who is personally known to me or who has produced
.: hMISSI$ C 7211 It
My Commission , 7. �� , s: EXPIRES: April 10, 2002
... X° Bonded Thru Notary Public Underwriters
APPLICATION APPROVED BY:
Chc7/7 /03
cr oN £ . .eta
n�nt�
2 4
Signature i� i/• ��� t
Contractor/
The foregoing instrument was acknowledged before me this
day of , 20 __, by
who is personally known to me or who has produced
take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No. O / t/ /3/
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SEP ° 2 2003
Plans Examiner
Engineer
Zoning