BPP-08-1887r
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type (circle): Building Roofing
Owner's Name (Fee Simple Titleholder)
Owner's Address I.- IV 1
City ki a viiC SL r +.m.._, State
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL # 10 G C. Co L\
Is Building Historically Designated YES NO
Contractor's Company Name
Conte, tor's Address
City
Qualifier Name
State Certificate or Registration No.
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $ 3 c ou
Type of Work: Addition ['Alteration
Describe Work: -
Submittal Fee $ 05 as c Permit Fee $
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
OV
4-
Tenant/Lessee Name Phone #
Job Address (where the work is being done) a...� 1`-° ! , l c) q . - 'ei- '
Zip - 5 3 ( - S<z3'
Zip
k'5? )1 ( Certifica tency No.
V Ut , e.A Phone #
['New
e****** *, x**: x**: x********* ***+ x*********** Fees***** ****** **********:x ***** **** **s *** * ******
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ 4e `.°--r Total Fee Now Due $ ® 7
See Reverse side ->
J
BY
Permit No.PC PZ
Master Permit No.
Phone #
- 3Z
Square / Linear Footage Of Work:
Repair/Replace , ❑ Demolition
eK(JO CCF $ /oL /9 C CC 5U
Notary $ Training/Education Fee $ 7 Technology Fee $ cc—J-7 --
Scanning $ %L . Radon $ DPBR $ • /? Zoning $
1
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 CONDITIONE' ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate an ork will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NO]'QIF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTYIF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY " RECORDING YOUR NOTICE OF
COMMENCEMENT." aT
Notice to Applican As a condition to the issuance of building permit with an estimated value exceeding $2500, the applicant must
promise in good f< ith that a copy of the notice of co nz e and construction lien law brochure will be delivered to the person
whose properly is subject to • ttachment. ; lso, a certified of the recorded notice of commencement must be posted at the job site
for the first inspection wh h occurs sev n (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will ' t be appr ed and a e spection ee will be charged.
who i
Sign:
Print:
Signature -1.10 /_ 1
Owne
rsonally know
My Commission Expires:
(Revised 07/10/07)
to me or who
ias produced
The foregoing instrument was acknowledged beforA me is
day of 200 tPO0 f l7.
As identification and who did take an oath.
NOTARY PUBLIC:
Contractor
The foregoing instrument was acknowledged before me this.
day of _ r_ ,20 ,by
who i
CAILA
* ...WIRES: COMMISSION # DD 589325
0 tober 3, 2010
* ***+x�x�x+z�x,�av+x**** * ***�xa: q::..:;' =<.t ri e1''wfm ****a ******* ** * * ****:x:x****� ****
OF 'PT
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
to me or who has produced
V RL IL- Coc
My Commission Ex$b ®� VICKI CECIL
E)�I ctober , 2 0
°. Bonded Thru Budget Notary Services
APPLICATION APPROVED BY: Plans Examiner
Engineer
Zoning
VSN4 VVZ.
Sootmt,
*M
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type (circle) Building A Roofing
Owner's Name (Fee Simple Titleholder) Or d+
Owner's Address
City 7 51zu_ State
Tenant/Lessee Name Phone #
Job Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL #
Is Building Historically Designated YES NO
Contractor's Company Name
Contrar's Address
City ty Alipa..W i
Qualifier Name c L ..6. - Phone #
Orr
W S L
Square / Linear Fo
:
ork:
•
dditio / ['Alteration New
I=1 Repair
State Certificate or Registration No.
Architect/Engineer's Name (if applicable)
O ®o
Value of Work For this Permit $ ,a "
Type of Work:
Describe Work:
'4, -
County Miami -Dade
Stater Zip
OC c) c.,
r ' i
1rt� 1 * * *** *** **** t**** *** **** * ** *** *** * **** *F ** **** ***** ******** ******** **** ****** ***
!k
Submittal Fee $ ' f Permit Fee $ ( 0 ) CC7 CCF $ las
Technology Fee $
Notary $ ii Training/Education Fee $
9 4•
Scanning $ 1 . 00 Radon $ DPBR $ O' 1 I
Bond $ / Code Enforcement $
Structural Review. $ 100 tar
Miami Shores Village p MOMEVM
Building Department OCT 2.7 2C08
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
�---
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit .No. e*x-i Ii
Master Permit No.
Phone # — 22? T7 & 5
zip 3 35
ID-ot Oevef
zip 51
Phone # q6`�7
ficate of Competency No.
hone # /1/( v� *4
❑ Demolition
Zoning $
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: 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 wh *ch 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
ner or Agent
The foregoing instrument was ac owled :ed before methi
,
day of ,2(2 ,by
n to me or wh'• produced
As identification and w
NOTARY PUBLI
Sign:
Print:
My Commission Expires:
(Revised 07/10/07)
2414_
VICKI CECIL
MX G� MMISSION # SD 589325
ES: October 3, 9010
Smiled Thw Budget Neary services
Contractor
The foregoing instrument was ackno ledged be ore me thig I
,20 ,by
known to me or who has produced
as identification and w
NOTARY PUBLIC:
- J abtP�Y p, „,
Sign:
Print:
My Commission Expires:
CECIL
SION # 9D 589326
Octobe
Thru BudiVispry Servkes
* * * ******** * *** : *********** ********* ***** ** *:x**************+x** ** :* *> k******* ***: ********** ** **+x*****•x********
APPLICATION APPROVED BY: .4 */11-- 1 fJu G J • Plans Examiner
Engineer
Zoning
PERMIT #54 Z
CONTRACTOR: 1 41 6S
II
— .
SUBMITTAL DATE: g --1
X
ADDRESS: 109 ■, 109 s
NAME: r...,rialie,
RESUBMITAL RTES:
PROJECT TYPE: V)
i)�57 °e
ZONING
FIRE
.4 li /J
SIiCTURAL �� , „� �,
IMPACT FEES
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HRS/DERM
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aFM4ANtcAL
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