BP-05-1289BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle):
City
Tenant/Lessee Name
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
Contractor's Company Name
Contractor's Address
City
Qualifier
Total Fee Now Due $
(Continued on opposite side)
, Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: 305 7952204 Fax: (305 756.8972
Ea
SEP n rgg5
A LI-91 '' Master Permit No.
Type of Work: ['Addition ['Alteration
Describe Work:
Electrical Plumbing Mechanical
County Miami -Dade
NO
Phone #
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit - t - $i5- Square Footage Of Work:
['New
Permit No ZOOS I 215C1
Roofing
Owner's Name (Fee Simple Titleholder) 1,415p Seim Phone # 7
Owner's Address
i z�f / ' `0.r -
State Zip
Phone #
Zip
Repair/Replace ❑ Demolition
Submittal Fee $ Permit Fee $ Caa (111 CCF $ 0,Kp CO /CC "—
Notary $J , CO Training/Education Fee $ 0 .Z0 Technology Fee $ 1 • 50 -
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) Al A
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 A14 (DAVIT: 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
Signa i ,4 /r j Signature
Own = or gent Contractor
The foregoing instrument , as , cknowle • ged be • me this The,fore oin ms e x + s acknowledged before me this
day o 20 I by 4 % ' \ 1� - , 20 , by
who is personally known to me or who has produced -- who is personally known to me or who has produced
* * * * * * * * **
AI As identification and who did take an oath. as identification and who did take an oath.
NOTARY P ' � iVy' .ujei Varp -,,Q PUBLIC:
Q
_ �9romission ,'
Sign: 0 0 _.► � F "-' - "to ' , 2 ' Sign:
Print: - 11� eit1ailtic bonding Co, Inc Print:
My Commission Expires:
My Commissio Expires:
**** ** ** * * ** * * *** * ** ** * **
************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
D ( I > 0 j Plans Examiner
Engineer
Zoning
APPLICATION APPROVED BY:
Chc 05/13/03
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ai/ip_.„-t, 7/03-
August 02, 2010
Building Department Official
Miami Shores Village Building Department
10050 NE 2nd Ave.
Miami Shores, FL 33138
Re: 1299 NE 104 Street
Miami Shores, FL 33138
Dear Building Official:
We would like to inform you that we have temporarily abandoned execution of permits:
permit # Dock -3 -07 -470 for concrete boat dock and Permit # BP2005 -1289 for house painting.
No work under these permits was done.
ester Jensen
::