PL-05-171Tenant/Lessee Name'
Total Fee Now Due $
0
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building
Contractor's Company Name A/O4
Contractor's Address A- a
City "VA
Qualifier et/ ,6
$ Value of Work For this Permit Q/J mb
(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
Electrical
Owner's Name (Fee Simple Titleholder) v a' ,5¢4,eX.r
Owner's Address 26 /e/e/. /0 g -r7
/ /4
City 4;i J2ies' State "G
,t7.;
Zip
Code Enforcement $ Structural Plan Review. $
.2er 4/.
Permit No. PUS — ti 1
Master Permit No.
.3 /erg
Phone # y/A
MAY 26
---------
Job Address (where the work is being done)
City Miami Shores Villas a Co Miami -Dade Zip
Is Building Historically Designated YES
Architect/Engineer's Name (if applicable) A7(4 Phone #
Mechanical Roofing
Phone # y :r- 7 S7 — 5' 7 97
State Certificate or Registration No y Certificate of Com
Square Footage Of Work: ,
Type of Work: ❑Addition ['Alteration ['New ❑ Repair/Replace El Demolition
Describe W o / rk: ,r� i / OoiL /� Co , v'/r-0,: / �iar fre v y, / ��D
I'� /3 9
t e / //isi /� /-rfh �srel elC ic0 / ca.v.,1c�e r
Submittal Fee $ Permit Fee $ /6e7 CCF $ CO /CC
Notary $ Training/Education Fee $ Technology Fee $ 4
Scanning $ Radon $ Zoning Bond $
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 R ORDING YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a buildin 411_0 ed value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of comment da yr- ction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a c d lb e=recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven d•,,.
f f 7 P (7) i t e building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
The foregoin
day of
who is personally
NOTAR
Sign:
Print:
li - , .61■2]likih,_ --
*******'** * * * * * * * * * * * * * * * * * * * * ** * * * - *� * ** * * * * * * * * * * * * * * * * * * * * * * **
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * * * **
* * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY
chc 05/13/03
Owner or Agent Contractor
ent was acknowledged before me this - The foregoing instrument was acknowledged before me this
20 _, by lay of , 20 , by
to me or who has produced �Q. 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.
Signature
NOTARY PUBLIC:
Sign:
- Print:
My Commission Expires:
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CJ
Plans Examiner
Engineer
Zoning