BP-03-1617Miami Shores Village elf 413 ®y
Building Department
BUILDING
PERMIT APPLICATION
FBC 2001
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No. 6319 Aon-1 11-
Master Permit No.
Permit Type (circle): Building Electrical Plumbing Mechanica 7�-
Owner's Name (Fee Simple Titleholder) ((l Cl1 Afo_ 7 Phone # 30E% 757- &2-517
Owner's Address - AA) 1 Q('! _c/
City iltU & State
Tenant/Lessee Name
Zip 3 /�
Phone #
Job Address (where the work is being done) N1) 10 0 `3t'
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's Address 'If Afe, tO (4 '
Architect/Engineer's Name (if applicable)
/V
Zip 33 ISO
Phone # , -75/ gi
. Phone #
Architect/Engineer's Address
City 'ti
$ Value of Work For this Permit 7f9, 0
State
Zip
Square Footage Of Work:
Number of: Bays Stories Families
Type of Work: ['Addition DAlteration ONew
Describe Work: ; c -t' l etuz ice& e ' °` "rLIVY
.�
Bedrooms
Baths
air/Replace 0 Demolition
County Escrow Fee $
********4** ****************Fees******************************
Permit Fee $ ` _ 0(�
Education/Training Fee $ a a 0 Tech $ R. o ,5 0
Code Enforcement $ Bond $
Minus Plans Check Fee $ Total Fee Now Due $
Notary $
Scanning $ 3 - Radon $
Struct. $ O D.
//[30
(Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
S
Zip
Zip
Application is hereby made to obtain a . ermit 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 t TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RE G YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant. As a condition to the issuance of a building permit with an estimate ue exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction Iranlaw 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 <tss In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged
Owner or Agent
The foregoing instrument was ac owledged before me
day ° T , 2 r, j by (Y h� k.�p (�
w o s Prsonalykno
NOTARY
Sign:
Print:
My Co
Ito nne or who has produced
As identification an ~ o ==dal i g -
LIC:
c
Bevel sc�.11 C. .°R -e�
-
Sigpa ire'
9
Contractor
The foregoing instrument was acknowledged before me this
day of , 20 , by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:.
Print
11 11� -'i
. * * * * * **
ires: Gt19e11 C River
MYCOMMISSION # CC89o39 EXPIRES
My Commission Expires:
op ' BONDED THRU TROY FAIN INSURANMINC (Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
*************4 4******************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * *.- *********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
OCT m 7 2003 Plans Examiner
Engineer
Zoning
APPLICATION APPROVED BY:
Chc7/7 /03