BP-04-1460BUILDING
PERMIT APPLICATIO
FBC 2001
Permit Type (circle): Building
Owner's Name (Fee Simple Titleholder)
Owner's Address % 0 /.J
City it r f i1l 5itotic State
Tenant/Lessee Name
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: 305) 795.2204 Fax: (305) 756.8972
ECEO VED
NO 0 0 2004
Job Address (where the work is being done) 9 0 IV E 9
S!.
City Miami. Shores Village
Is Building Historically Designated
Type of Work:
Describe
Submittal Fee $ 200 •00
Notary $
Total Fee Now Due $
•(Continued on opposite side)
q 7 sr pp
Ft, • Zip ��t 3 C�
Phone #
YES
$ Value of Work For this Permit ;70 000
['Alteration
Electrical Plumbing Mechanical
S bill e»f LL) . 'PEE Sihone #
County Miami -Dade Zip 33138
NO
X
❑New
Zoning
Permit No.
Master Permit No.
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Square Footage Of Work:
2. oWi K 6." ees
Permit Fee $ CCF $
Training/Education Fee $ Technology Fee $
Scanning $ Radon $
Code Enforcement $ Structural Plan Review. $ •00 -+
c'c x.50.00 .
Bond $
6P01-1-1q64 d
Roofing
SOS ;7 7 +30`S
Contractor's Company Name 61p1-1 Phone #
Contractor's Address
City State
Qualifier
Zip
14 -0
❑ Repair/Replace ❑ Demolition
1111 AI A WA AI 41
COICC
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 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
NOTARY
Sign:
Print:
My Co uu' ion, Expires :
* * * * * * * ** * * * * **** * * * ** * * **
A *
APPLICATION APPROVED BY:
Chc 05/13/03
er or Agent
The foregoing instrum was acknowledged before me this e5
day of U , 20(4, b ac rolne €(03e• /� I.
who is personally wn to me or who has prdducecL D
As identification and who did take an oath
t h ' Atttiltit
* * * * * ** * * * * **
log
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of ,20by
who is personally known to me or who has produced
•
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
M}) Commission Expires:
• * -
i y. f
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
fi vtou.5 - 1 £ 20 07
I`J,Mi SHo s Dep7
Mliq'Nlf a1lor -
19d5O 2110(
rltrn?t Ites PL. 33138
7"p
0 31+011 ► r ti't-y owe 1
Would yot4 1 0e go k.11;1 a s 4 o ca vi cell tM y
etc! S# (46a '1 b(A !° " pevA4;f- froNi 2004,
lr5 T a Guvrehf'1 y dDlvt j w ovrk. l ei' an
e rm f of). RG 12 -oS (28(• The Work is oK
P .
re 5 of qtD Nf 97 Sr. In T'l ! Shak-e.5
Thank rt ( .
SIDIJ Reese