FENCECity
Qualifier
p
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle • Building Electrical Plumbing Mechanical
Owner's Name (Fee Simple Titleholder) ' t
74-7- N 8' 5
Owner's Address
City
Tenant/Lessee Name
Job Address (where the work is being done) � r / L
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name et, S i t L4 G 7/ "
Contractor's Address 1L,�, 00 l / S C Ai 4'7
Of /'�`'i2
j ( Tt r_
$ Value of Work For this Permit
State
L_ CD, i
County Escrow Fee $ a
Education/Training Fee $
Code Enforcement $
Minus Plans Check Fee $
Miami Shores Village
Building Department
State Zip
Phone #
J Z2
Number of: Bays Stories Families
Type of Work: ['Addition ['Alteration [New
Describe Work:
Phone #
Bedrooms Baths
* * * * * * * * * * * * * * * * * * * * * * * * * ** *Fee Calculation -Misc Permits * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Permit Fee $ , t
Notary $S . o D
Tech $ v Scanning $ Radon $
Bond $ Struct. $
Fee Totals $ f 1 0
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No.
Master Permit No.7 P Z Oa3 - !DO
Roofing
34)S a
Phone #
Zip
Architect/Engineer's Name (if applicable) . - Phone #
Architect/Engineer's Address
City State Zip
Square Footage Of Work:
❑ Repair/Replace ❑ Demolition
(Continued on opposite side)
Bonding Company's Name (if applicable) T
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 se en (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a einspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this
4
Contractor
The foregoing instrument was acknowledged before me this
day of , 20 , by
who is personally 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.
,20U ,b
Signature
NOTARY PUBLIC:
® r :ec.er
Sign:
F My Commiasinn np, cooio Print:
as identification and who did take an oath.
74 `
Expires November 15, aooe
My Commission Expires: My Commission Expires:
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency, No.
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc6/18/03
ta, 6/2- Yo 3
Plans Examiner
Zoning
£L1140 pi uperty aescribed as:
411 og Lot 5, and the East
112 of Lot 6, Block 31
AN AMENDED PLAT OF MIAMI SHORES
SECTION NO. 1,
according to the plat
thereof, as recorded in
Plat Book 10, Page 70
of the Public Records of
Dade County, Florida.
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Loan
ors
PROPERTY Of: Leoni, Victo 262 N.E. 98th gtreet, Miami Shores F'lor
LANNES AND CAIltr'IA INC.
1..11. 211911
SIIRVEYORS- 111A1'1'1':Itti -LAND PLANNERS
BEAIM SMITH 15238
(litho? usldleva: AS9 Airliner Arrant. ('oral (:aides, Florldb.101.1.1
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Miami Shores Village
10050 NE 2nd Avenue
Miami Shores, FL 33138
Inspection Record
Inspection #: INSP2004 -496
Address: 262 98 ST NE Reference #: BP2003 -1017
Applicant: JAY ALLISON
Directions To Parcel:
Inspection Type: Final Building
Inspector: Curtis Craig
Passed? E
Required Steps:
Comments:
Inspection Checklist:
[ZlBuilding ❑
❑Site ❑
❑ Final Survey as Built ❑
❑ Certificate of Occupancy ❑
❑ ❑
❑ ❑
❑ ❑
0
Page: 1
Printed: 7/19/2004
Date: 2/3/2004
Status: APPROVED