BP-05-6243)a01 l -rtgnev-7 Miami Shores Village
(?(1UCJtD 5/ Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
el: (305) 795.2204 Fax: (305) 756.8972
APR29
(Roo af-b3
BUILDING
PERMIT APPLICATIO
FBC 2001
Permit Type (circl
Owner's Name (Fee Sim
Owner's Address
9nn
Electrical
Tott:aiu.
Master Permit No.
Plumbing Mechanical ( Roofing
�l
Phone # 3CG-
1 "- O
90 l
City c = State . L Zip
N(--6t
Tenant/Lessee Name
Phone #
Job Address (where the work is being done)
Idq 0,0ci&
City Miami Shores Village County Mi = i -Dade
Is Building Historically Designated YES
Contractor's Company Name
Contractor's Address
City
Qualifier
NO
Phone #
Zip
State Certificate or Registration No.
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit
Type of Work: ❑Addition
Describe Work: R CQ I(
Certificate of Competency No.
Iteration
1
[New
�Lu1
Phone #
Square Footage Of Work:
❑ Repair /Replace ❑ Demolition
** * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ � Permit Fee $ tie(i) CCF $ t 6°()' CO /CC
Notary $ Training/Education Fee $ C �I . (/ Technology Fee $ ! _5"
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $"'
(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 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 co
promise in good
whose property
for the first i
inspection wil
dition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
ith that a c of the notice of commencement and construction lien law brochure will be delivered to the person
bject to att ' chment. Also, a certified copy of the recorded notic mmencement must be posted at the job site
n which s ccurs seven (7) days after the building permit i In the absence of such posted notice, the
,pproved ind a reinspection fee will be charged.
Contractor
The foregoing instrument was acknowledged before me this
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.
My Commission Expires:
���
* * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * ** ****************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
NOTARY PUBLIC:
Ginnysa:Gonell
Commission #UD323870
Expires? '1i #: 26.2008
�#? Bonded Tm
h
Atlantic My ":Cpnnnnission Expires:
APPLICATION APPROVED BY:
chc 05 /13/03
MAY - 3 2g5
Plans Examiner
Engineer
Zoning