MC-04-199• Miami Shores Village
Building Department
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building
.A -K Y 9 56897
/0050 N.E.2n Avenue , Mi 33138
.
T � . tea• 56.8972
Electrical
Owner's Name (Fee Simple Titleholder) C. G p Lea-n, ca,s L
'Owner's Address 113 /t &to `C ,( 4
City Mum ° State l
Plumbing
Tenant/Lessee Name Phone #
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
Contractor's Company Name
Ul n i v - e9 .5w. I
County Miami -Dade Zip
NO X
)L
Contractor's Address S L I (o b l.J
City State f!
Qualifier i C ,o- os►�7J0�
I a
Architect/Engineer's Name (if applicable) Ai ont S t A (O, C.
$ Value of Work For this Pe Square Foota
Type of Work: ❑Addition grAlteration
Describe Work
Total Fee Now Due $
(Continued on opposite side)
A/c .y11.S1-4//4,4 01
Permit No.
aster Permit No.
Zip 33/6J
Phone #
4- Phone # s - S$J- 7 / ! (a
Zip 333p/
/ e0o0 ct —r
Roofing
3OS-7s -
331
•'« •
❑New 0 Repair/Replace ❑ Demolition
/�� ****************************F rr� *+rss+�,� # *rw * *+��+sarsrrrrr
Submittal Fee S�-��T Permit Fee $ CCF $
Notary $ Training/Education Fee $ t Technology Fee $ r
Scanning $ G j Radon $ Bond $
Code Enforcement $ � Structural Plan Review. $
Bonding tom y'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 4i&, a 'riffled copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs s en i rthe building permit is issued In the absence of such posted notice, the
inspection will not be approved and a reinsp
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this
day of A.c , 20 Oct, by niA rA l ,
who is personally known to me or who has produced
As identification and who did take an oath.
N PUBLIC:
Sign:'
Print: , c9 :� +� 01 9 Qt
MY (141M® ree, El e � u `C' 1 My Commission Expires: yc► Colby O'Brien
SO b o
* �0 � ® l * * * * * *,e * * * ** ** �** Asa***** ** * * * * * * * * **e�,x**** **** *** * * *a 11i ssita1202681iD
4g Expires March ti, 2007
v Bonded Thru
��i,� Fi„�P ° Atlantic Bonding Co., Inc.
State Certificate or Registration No.
Chc 10/14/03
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, ,A
APPLICATION APPROVED BY: �
Engineer
Zoning
(Certificate of Competency Holder)
NOTARY PUBLIC:
Sign:
Print:
Contractor
The foregoing instrument was acknowledged before me this 9
day of 1. 20 , by mih-e. 7 0A,JO-, ,
who is <<a can. yIn.' to me or who has produced
as identification and who did take an oath.
**
of Expires November 24, 2007
Certificate of Competency No. I
* * * * * * * * * * * * * * * * * * * * * * **
weepl Plans Examine'