MC-04-169RAVED
3 1 2004
Miami Shores Village
Buildin g Department artment . 4 )3/v
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2001
Permit No.
Master Permit No.
Permit Type (circle): Building Electrical Plumbing Plu�mbbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) 4L %U5 P1- sI Phone #
Owner's Address 3
d(
City MI 1511
Tefiant/Lessee Name
Job Address (where the work is being done) J 1 J 9 )4,101, J--1141.,...e T
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES
NO�
Nlk
Contractor's Company Name R k) D IT( OJT`) N &Phone # 36 C 6,1— 3/
Contractor's Address foci( 6 5 oJ
City /14 WA / State pc:, Zip `3,/
Qualifier DA-kJ i iD D 0 (s c.
Architect/Engineer's Name (if applicable) Cqck Phone # es 51 1' 99,61
Square Footage Of Work: Ofl S%
$ Value of Work For this Permit
Type of Work: ❑Addition ❑Alterationyl ❑New LV1' Repair/Rte�place ❑ Demolition
Describe Work: yy��fs gpQM a ,44410 � c.�c�i� ����j/ Dog
affsimmemilm-AnnirmieP
* * * ** * * * * ** * * * * * * * * * * * * * * * / * *�F ees * * * * * * * * * * * * ** * * * * * * * * * * * * * * **
Permit Fee $ (5 r; CCF CO/ C;
Notary $ p 6 Training/Education Fee $ , � Technology Fee $ S• 0 0
Submittal Fee
Scanning $
Radon $
Zoning
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $
(Continued on opposite side)
Bond $
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) 7
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 A lTDAVIT: 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 '.sues. In the absences su posted notice, the
' nspection will not be approved and a reinspection e will be charged.
Signature
Owner or Agent Contractor
The foregoing instrume was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 , . day of 406. 31 , 20 v (1, by
own to m or o has produced who is personally known to me or who has produced 0
NOTARY PUBLIC: NOTARY P
Sign: Sign
Print: Prin
My Commission Expires:
My Commission :Expi t
re5.Nn,MDer 1 S, 2006
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
°` _ ( 9 a C—C Plans Examiner
Engineer
Zoning
Chc 12/15/03
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: MC2004 -169
Printed: 9/7/2004
Applicant: ALEXIS POWELL
Owner: POWELL ALEXIS
JOB ADDRESS: 313 NE 92 ST
Mechanical Permit
Contractor
D & M AIR CONDITIONING AND APPLIANCEContractor's Address: 6440 S. W. 44 ST.
Local Phone: 305 - 669 -1931
Parcel # 1132060136360
Page 1 of 1
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 13 & 14 BLK 47 LOT SIZE 100.000
Fees: Description Amount
FEE2004 -8980 Building Fee $200.00
FEE2004 -8981 CCF $1.20
FEE2004 -8982 Notary Fee $5.00
FEE2004 -8983 Training and Education Fee $0.40
FEE2004 -8984 Technology Fee $5.00
Total Fees: $211.60
Total Fees: $211.60
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 2/27/2005 Construction Value: $1,200.00
Work: REPAIR AND RELOCATE EXISTING DUCT WORK
Signed:
(INSPECTOR)
8 PAID
J1c7-
In consideration of the issuance to me of this permit, 1 agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict
conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY: