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MC-08-2100BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Mechanical Owner's Name (Fee Simple Titleholder) ( 1 r -� — IL9- Phone # — Owner's Address laq / oefdk S City t AA 5 State Zip Tenant/Lessee Name E -MAIL: Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # Is Building Historically Designated YES Contractor's Company Name Contractor's Address I ' 4_3 City G 1 . !_hi_ 1 I . State c 40\Py' Qualifier Name State Certi irate or Registration No. E -MAIL: C ` Architect/Engineer's Name (if applicable) Value of Work For this Permit $ Type of Work: Addition ['Alteration Describe Work: Structural Review. $ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 County NO Miami -Dade 6 l I Certificate of Competency Square / Linear Footage Of Work: ❑New Permit No. O&ioo Master Permit ro.?99` O �� ;,!)1 5U Phone # Zip Phone # C54 -a,2.27 7 '5 Total Fee Now Due $ 064 ❑ Repair /Replace ******** * * ** * * ** * * * * * * ** * * * * * * ** * *xxxxx Fees****** * **** * * * * * * ** * * * * * *x * * * * * * * ** ** Submittal Fee $ Permit Fee $ Notary $ Training /Education Fee $ Scanning $ Radon $ DPBR $ Bond $ Code Enforcement $ Double Fee $ CCF $ CO /CC p ^ °� a "9,, .BP"� BY: ��✓ ❑ Demolition Technology Fee $ Zoning $ See Reverse side -+ cLe 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 fWICE FOR IMPROVEMENTS ORTO �OUATTORNEYTYBEFORE YOU RECORD[ G OBTAIN NOTICE FINANCING OF CONSULT WITH YOUR LENDER Notice to Applicant: As promise iii goo faith t whose proper j is subj for the first i _ pectio inspection wiflnot be Signatur Owner The foregoing instrument was , edged before ( e ( th' day of ..�, 2 , by `C A I C k.l he.cu114. who is r rso "" n t� me or who has produced As identification and who did take an oath. (Revised 02 /08/06) condition a copy t to attach hich occ proved a Print: V v` t , rot c t 1 �o ,... � , VICKI CECIL * My Commission Expires: MY COMMISSION 9 BD 589396 AfiligaiaGNA384 MD* %"" " % % % % % % % % % % % % %a�9 4. OFR 'P o es O Seeded Thru Budget Notary Services APPLICATION APPROVED BY: the issuance of a building permit with an estimated value exceeding $2500, the applicant must he notice of commencement and construction lien 1 ent. Also, a certified copy of the recorded notice s seven ) days after the building permit is iss a reinsp i ion fee will be charged. % %%xxxx Contractor The foregoing instrument was ackn wledged before me this �Z day of _ 20aq by who is ersonally kn me or who has produced as identification and who did take an oath. NOTARY PUS , IC: Sign: Print: My Commisss U 11 1 ochure will be delivered to the person # ecement must be posted at the job site the absence of such posted notice, the a<, VICKI CECIL p rin:COMMISSI ©N 9 DD 589326 x 3 * * * * ** * Seeded Thru Budget Notary services Plans Examiner Engineer Zoning Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING RECEIVED Permit NOV, 01) Int PERMIT APPLICATI 0 N DEC 0 an Master Permit No. FBC 2004 I Pf } � NO GO Permit Type: Mechanical Owner's Name (Fee Simple Titleholder) Owner' Address City Tenant/Lessee Name E- MAIL: Job Address (where the work is being done) \ )-A l City Miami Shores Village , County Miami -Dade FOLIO / PARCEL # 1 uC� q Is Building Historically Designated Contractor's Company Name Contractor's Address T p� q. City P.1.4 .0 State Zip l./�'�J Qualifier Name 51444 . State Certificate or Registration No. C. PC,IC e '"` D ' ` Certificate E -MAIL: Architect/Engineer's Name (if applicable) L) r V Ril , Phone # `� ( '13 3 g z Value of Work For this P mit $ Type of Work: Addition Describe Work: Structural Review. $ ❑Alteration 6 ‘ALetrotg) Submittal Fee $ Notary $ Scanning $ Radon $ Permit Fee $ Training /Education Fee $ NO * * * ** *Fees * ** 1 0 0 Bond $ Code Enforcement $^ ble Phone # Phone # (1l --?(7)- --)5 Square Linear Footage Of Work: ❑ Repair /Replace ❑ Demolition ***** Kaz** * #xxxx * * * * * * * * * * * * * * * * * * * * ** ** CCF$ Zip CO /CC Technology Fee $ Zoning $ ot Fee Now Due $ tn(-1 See Reverse side S26) 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 <' a ?- ;y ? Zip Application is hereby made to obtain a permit to do the work and instatll`ations indicated. 1 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. 1 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: 1 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 est at�ciFue exceeding $2500, the applicant must promise in good faith that a c•py of the notice of commencement and construc li •w brochure will be delivered to the person whose property is subject to %ttachment. Also, a certified copy of the re • : n• , of commencement must be posted at the job site for the first inspection whi.- occurs seven (7) days after the buil s issued In the absence of such posted notice, the inspection wil ?.ot be op. • ed and a reinspection fee will be chat Alf t - rir Owner or Agent Signature The foregoing instrument was ac owled ed before me this `1 The foregoing instrument was acknowledged before me this(, 1 day of 20 ' by t A o� , day of , 20 Qy own to me or who as produced s per to me or who has produced As identification and wh td take an oa as identification and NOTARY PUBLIC: Sign: Print: (Revised•02 /08/06) My Commission Expires: APPLICATION APPROVED BY: viGKi CECIL jo * lei COMMISSION # 00 599325 EyiPIRES: October S, 211 ''4.6,,, veo dad' s Burt NON Services Signature : �� Contractor VICKI CECIL MY COMMISSION 8 00 969325 DOVES: ES: October S, 2010 6sded Mrs Budget Nstaly Services Sign: Print: My Commission Expires: NOTARY PUBLIC: A ta �P�8 Plans Examiner Engineer Zoning