1240 NE 100 St (3)355
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date St oZ� Time ,{^,^
Type Insp'n 0-J00 1c 1
Permit No. 1 213C5
Name
Address 2 `O N ( w s+
Company ?QUO 1 ?(c S
Phone # l /3 7 `t �'C
For Inspector: P I2, ame & Date
Approved
Correction
Re- Insp'n Fee ❑
otc>91(1
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date QI g Time
Type Insp'n d1'IVL° [1X .r RM.)
Permit No. BPaoo3• 13a(9
Name 11e b i kJ o C Of Ce 1( 3
Address 1P40 N E 100
Company Ru/ c°rpro
Phone# 305.a1q•gtoaq
For Inspector: Q I q
Approved
Correction
Re- Insp'n Fee
Name & Date
�F CCU J` E113
AUG 1 2 2003
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle):
Contractor's Company Name
Contractor's Address 3 3/
City M r /
Qualifier 7/4-ti V b
S Value of Work For this Permit
Miami Shores Village
Building Department
g Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) ( M1LDO coti�e; Phone #
Owner's Address t 24 J'(i 1 00 St
City /tit i tit i S'HGPtES State FL Zip 331 Y8
Tenant/Lessee Name Phone # 305. (93 2004,
Job Address (where the work is being done) S•/''t G •
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO
�9 ✓6 P,2
sus / t 3 t =�
State
Fia 6✓A✓.bE' 2
Architect/Engineer's Name (if applicable) - Phone #
Architect/Engineer's Address
City
State
4..
Number of: Bays Stories Families
Type of Work: ❑Addition ❑Alteration ❑New
Describe Work:
County Escrow Fee $ • 6 v Permit Fee $
Education/Training Fee $
Code Enforcement $
Tech $
Bond $
Permit No. r ?ow, i37-0 .
Master Permit No.
Phone # 5^ 2/ y y 2 G/
Zip
Square Footage Of Work:
Bedrooms Baths
❑ Repair/Replace ❑ Demolition
Zip 3 '
* * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Minus Plans Check Fee $ Total Fee Now Due $
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Zip 3 3 r7
Notary $
Scanning $ Radon $
Struct. $
(Continued on opposite side)
Va o 4 CO C -C
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:
promise in good fait
whose property is sub
for the first inspect
inspection will not b
Owner or Agent f ( Contractor
The foregoing instrument was acknowledged before me this 0 The foregoing instrument was acknowledged before me this
day of Lt L 20 03, by day of LL. 20 tt-) by
who is perso4fally known to me or who has roduced
P who is personal y known to me or who has produced
• As identification and who did take an oath. as identification and who did take an oath.
NOTAR ! ' IJBLIC:
Sign:
Print:
My Commission Expire
OF Fl EXPIRES: Mar 14, ZOOS , ~
1 - NOrnRV
**************** * * ***** * * ** * * * ** * ** * * *,r * ** * *** inc.
chc7/7 /03
ition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
• of the notice of commencement and construction lien law brochure will be delivered to the person
ment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
rs seven (7) days after the building permit is issued. In the absence of such posted notice, the
a reinspection fee will be charged.
State Certificate or Registration No.
L <Lit /2 7S//
NOTARY PUBLI
Sign:L<
Print: , � ° SHIRLEY
My Commission Expir 'tore' MY(CXP►R Mar 14.2005
�
1
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * • 64F4c **adrowl,
(Certificate of Competency Holder)
Certificate of Competency No.
APPLICATION APPROVED BY:
AUG 1 2003
Plans Examiner
Engineer
Zoning
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