Loading...
BP-05-1275BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical Plumbing Owner's Name (Fee Simple Titleholder) 1...40 lure (70d L? Phone # 3C/S 1 757 63 e Owner's Address J -93 /tJ /04 St /n City J('n Ski. eYe .S State Zip /3 2 Tenant/Lessee Name Job Address (where the work is being done) Mei 3 `Ld1 /C7/ . City Miami Shores Village County Miami -Dade Is Building Historically Designated YES NO (1--"'" Contractor's Company Name 1)4.104 lUtt Contractor's Address Type of Work: Describe Work: Submittal Fee $ Notary $ .-- Scanning $ 3.00 Code Enforcement $ Total Fee Now Due $ (Continued on opposite side) State Certificate or Registration No. U( ,.0 5' 7 1 `J 0 Architect/Engineer's Name (if applicable) $ Value of Work For this Permit fl 77 i go zCZ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (3 < . '_ ., . !_ -- ,..8972 "tiff i� Stat AUO l 3 0 2 Permit Fee $ 10 Training/Education Fee $ ©. Z'0 Certificate of Compe ******* *********************Fees****************************** * * * * * * * * * * * * * ***** * * * * * * ** Permit No. .7'ps - 1215 aster Permit No. Phone # Phone # Mechanical Zip 331 35 Phone # Roofmg Sac 9 Square Footage Of Work: el-S /0 ['Addition ['Alteration ['New Repair/Replace ❑Demolition R U A-PPtiony. 10 P h/L21 0 (ACE:- CCF $ 0.60 CO /CC Technology Fee $ Z • '50 Radon $ Zoning Band $ Structural Plan Review. $ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 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 i el1OQQ '+ - J /gyp',. Owner or Agent T Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ,Q' / , 20 05, by day of , 20 _, by who is personally known to me or who h produced ( who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: 4, kt z 1,. 1 v ,-,-,,.. u L �� Corrn fission $!'rf01g7516 Print: 7.� a , � 'c` 3/27/2007 My Commission Expires: 5 � ® % „ • nm Bolded through My Commission Expires: =(800.4324254) Florida Notary Assn., Inc e NOTARY PUBLIC: ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *****f***** * ** * * * * * * *. * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: Chc 05/13/03 k._, Zip Zip v N�� S Plans Examiner Engineer Zoning