BP-05-1422BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Elec i al ' lumbing Mechanical
Owner's Name (Fee Simple Titleholder) y()€44_, k /4, 7.S3I/� y Phone #7e6 - 55 sv .
Owner's Address 599 h6� Q4' j/ ,: "!
City A4/4117/ K S//b1 a State 1t. , Zip /J,5
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 5'2 9 /06 !' 5f
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO_
Contractor's Company Name DeLQp ieQ Phone # 566 2P `r
Contractor's Address 9‘f NN J/
City Pl 'ill 511 ares State
Qualifier
State Certificate or Registration No.
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit 4 ,R c5i DO
Type of Work: ❑Addition ❑ ❑New Repair/Replace ❑ Demolition
Describe Work: f �1®t I (o'i �G 9.0 f -r Th - f / , 12,€-PA-1 (,t71 I)-1
rnooi pa f WC-) WC-) an V1CX � CErn&A.YT. s - nortL 11 .
c9) Pfifi ; '> t r l 911- J j j "T1 L A-T IMIZ4 QQ LOC it
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ i° 6 % • CCF $ 1 .2t7 CO /CC
Notary $
Scanning $ 3 •
Total Fee Now Due $ 1 12. •
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.3.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Certificate of Com
Permit No. 06 — 1 4 22
star Permit No.
Zip 33/37
ziN3S131
Square Footage Of Work: fl/O y' alto 5 F
Training/Education Fee $ P . 40 Technology Fee $ 2
Code Enforcement $ Structural Plan Review. $
Radon $ Zoning Bond $
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 der the building permit is issued In the absence of such posted notice, the
inspection will not be approved and a reinspectio i ee will be charged
(7 ignature
Owner o Agent / Contractor
The fo going instrument was acknowledged before me this 2 The for' d = t was acknowledged before me this
cby(`
day , 20IC.,"/ Kt N of 1 ', 20 _, by
who is personally known to me or who has produced
Signature
who is personally known to me or who has produced
IN As identification and who did take an oath. as identification and who did take an oath.
NOTARY P i : N OTARY PUBLIC:
Sign: . V / _ i ( Sign:
Print: `' c- /. «r A5p. Print:
n Expires:
e, * * *'Y
it Commiss
,r. *= Expires:
o ** * Nair
My Commi
* * * * * ** a4`
APPLICATION APPROVED BY:
chc 05/13/03
My Commission Expires:
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40J Plans Examiner
v Engineer
Zoning