BP-04-1244BUILDING
PERMIT APPLICATION
FBC 2001
Tenant/Lessee Name
$ Value of Work For this Permit y . G9 j 7
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
Kaln
.2nd venu
fj305) 95
Permit Type (circle): Building Electrical Plumbing
Owner's Name (Fee Simple Titleholder) X C,ci/ Phone #
Owner's Address X 4e2.? /C/• p 6l/1f- T
City _5{D S' State ile /Jr
x N/
Job Address (where the work is being done) X 6 T�! C 96 S
City Miami Shores Village County Miami -Dade Zip 3 5/3g
Is Building Historically Designated YES
NO
Contractor's Company Name 0 Na r I eri Cut pe ppe Phone # 4c
Contractor's A d d r e s s ent t r i r; CCqb d d r t'
Cit ' :A fi`12 State L
Qualifier Cll it .t Gtr a
State Certificate or Registration No. Certificate of Competency No. X 6'&
Architect/Engineer's Name (if applicable) Phone #
)(Type of Work: ['Addition ❑Alteration New
Describe Work: 07&o (2) i1/ / AfT32 />, '
Zip .3 3/.3f
Phone # 10
Zip ?j- 1 a
J Rep
epartment p
horns, Flo 138
972
Mechanical
Square Footage Of Work:
* * * * * * * * * * * * * * * * * * * * * ** * * * ** Fees ** * * * * * * * * * ** * * * * * * * * * * * ** ** **
Roofing
❑ Demolition
Submittal Fee $ Permit Fee $ CCF $ CO /CC
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
Mortgage Lender's 5 (if ap icabl
Mortgage Lenderttldr
City
Signature
day of
who
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 ,gig, ed notice, the
inspection will not be approved and a reinspection fee will be charged
The foregoing instrument was acknowledged before me this a foregoing instrument was acknowledge' . e ore me
20 Q , by go / i( / A,, t , day of OC-1t)6 er' ,20D , by fit' C.4.44 61;
Owner or Agent
me or who has produced
As identification and who did take an oath.
7! rr*s
NOTARY PUBLIC: `' " , NANCY GONZALEZ
' ` �f• MY COMMISSION # DD 2716633 Nc
%�"� '
Sign: / , e ILA--- � T EXPIRES: February 15, 2006
, Irf4hg BordedThru Dory
Print:
------61-74 GB
My Commission Expires: 3- -7D o r-
Chc 05/13/03
Signature
e
,,,,
rte,„
/ s NANCY GONZALEZ
II:r
EXPIRES: Feb 15
�Y 2008
a?' rBaMed Ttw Notary Pubk UrMermiters
who is ersonall .., . •.�,. me or who has produced
as identification and who did take an oath.
ARY PUBLIC:
Sign:
Print: .cam troy y, /cam
My Commission Expires: ),/or
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APPLICATION APPROVED BY: Plane Examiner
Engineer
Zoning