EL-06-1240Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
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Tel t� . 756.8972
BUILDING �Y 1 2 006 Permit No. _ -- 12-
PERMIT APPLICATION B Y: Master Permit No.
FBC 2001
Permit Type (circle): Building
Owner's Name (Fee S'
Owner's Address
Ci
e Titleholder)
.-
Jr
g� Zip
Plumbing Mechanical Roofing
Phone # '93 4
Tenant/Lessee Name
Phone #
3G — ae, s.
Job Address (where the work is being done) / 74/ PE 7 '1
City Miami Shores Village County Miami Dade Zip 4B/9
Is Building Historically Designated YES NO
Contractor's Company N
Contractor's Address
City
Qualifier
Phone #
Architect/Engineer's Name Cif applicable) Phone #
$ Value of Wo r k For this Permit Lam°
Square Footage Of Work:
Type of Work: ❑Addifioy ❑Alteration ❑New ❑ Repair/Replace ❑ Demolition
Describe Work:
..**********.***************Fees******************************
Submittal Fee $ 0 Permit Fee $ /469rf� ,
Notary $ Training/Education Fee $ 0.
Scanning $C7.) . Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
CCF $ C-72) QDCD CO /CC
Technology Fee $ Chi
Total Fee Now Due $ icco
(Continued on opposite side)
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 ET.F,CTRICAL 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 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
Owner or Agent
The foregoing -instrument was ow1edgedbofor VIP --this The- foregoing- instrumen wasicknowledged before me-this - --
day of , 20 by , day of , 20 , by
who is personally known to me or who has produced 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.
NOTARY PUBL
Sigo:-
Print : d dry udeS tc oel Ana
My Commission Expires: Ply .;o att i6')D4486bi
Etrifebo
***** *********U ***** ** *****
NOTARY PUBLIC.
Sign:
Aretina
at~ .l�Et
k#i '& r e**aYae** *****
* * * * * **
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
* * *YF * *** ****
******************** * * * ** ** * * * * * * ** * * * * * ** * * ** * * * **
APPLICATION APPROVED BY:
Chc 12/15/03
****************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
/3 /yGe %`Plans Examiner
Engineer
Zoning
w
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: 07/17/2007
Inspector: Devaney, Michael
Owner: BLACK, BRIAN
Job Address: 1294 96 Street NE
Miami Shores Village, FL 33138-
Project: <NONE>
Contractor: BRINKS HOME SECURITY INC
Permit Type: Electrical - Residential
Inspection Type: Final
cloves
Work Classification: Addition /Alteration
Block:
Phone Number (678)986 -2032
Parcel Number 1132060143840
Lot:
Phone: 305 - 887 -8455
Building Department Comments
BURGLAR ALARM
L °x02007
Passed
Inspector Comments
' f „cll.- -
) ."- .''''
t7.
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid .
until
Monday, July 16, 2007
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