BP-05-1531BUILDING
PERMIT APPLICATION
FBC 2001
City/Li/am/Sher State
Tenant/Lessee Name
Contractor's Address 7 /U £ / 0 L,.
$ Value of Work For this Permit ' to 16
Submittal Fee $
Notary $5-
Scanning $ 3
Code Enforcement $
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit Type (circle): Building Electrical �� Pllumbing Mechanical
Owner's Name (Fee Simple Titleholder) / f , Ale tff ./ t Phone #
Owner's Address 59 I/ /Q/
Job Address (where the work is being done) 59 £ /0/ /-
City Miami Shores Villas e
Is Building Historically Designated YES
County Miami -Dade
NO
Contractor's Company Name b tPhone # 36 251 e Z ?
Permit No. f200 - 153
Master Permit No.
Zip 33/3
Phone #
Z /0g
City I aM State Zip 3313 g
-,4
Qualifier D a ki i if - - DAL
State Certificate or Registration No. C - i0 5 / 1 ') 0 Certificate of Comp
Architect/Engineer's Name (if applicable) / Phone #
Square Footage Of Work: - KS f"
Type of Work: DAddition DAlteration DNew [ kee'pair/Replace D Demolition
Describe Work: afili IL 2- - \ /COOT O t. WO ,.1, H1)S€
A 4 0 t e) £ K -Oo(°.
M.A...ftez, Pee Pa-0,7c 5 1011) -
****************************F
Permit Fee $ /v 6 e CCF $ a. (oO CO /CC
Training/Education Fee $ 0 - c)J Technology Fee $ a .J
Zoning Bond $
Radon $
lL I .
Structural Plan Review. $
Bonding Company's Name (if applicable) 4
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 cons Iron lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the rec e, Wee of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the di p is issued In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be char
Signature
Contractor
The foregoing instrument was acknowledged ' this 23 The foregoing instrument was acknowledged before me this
. •�� •
" Qday of
day ofd`, 2t
who is personally
NOTARY
Sign:
Print:
My Co ission Ex
APPLICATION APPROVED BY:
chc 05/13/03
own to me or who has produced
As identi `if ,and 1t
:;b.... ',n #DD.
• _ 1984
�.- .�...._ ..,..._.._. , , 2007
Signature
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
,20_,by
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/I b3 Plans Examiner
Engineer
Zoning