BP-05-581Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax ,(305) 256.8972
get"-
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Permit No.
ry` faster Permit No.
Electrical Plumbing ''-e 'Mechanical Roofing
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle):
Owner's Name (Fee Simple Titleholder) C VI rOg.._ t Phone # 6,
5 7
m 0 l 4
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Owner's Address
City Mr tOAA44 PO State
Tenant/Lessee Name
Zip 33I8
Phone #
Job Address (where the work is being done) 1 0 43o Ni t 3
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO
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Contractor's Company Name wl� ST C i 1 O J PT 1 Phone # J� 7 41 (. � ` (°
Contractor's Address 7 I OD TDVSC. E _ UT) . * -5
City Pit I4 j State ► Zip 33 13
Qualifier
VtcT v2
State Certificate or Registration No. Ce)L 0?' Ie 4 7 Certificate of Competency No.
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit
4 „1-5-6-D'''
Phone #
Square Footage Of Work:
Type of Work: ❑Addition DAlteration ❑New \ ❑ Repair/Replace Z4 Demolition
Describe Work: R cMOVE �C'( ST1 t i 1(.11-GUt�a.� �G e S 4 i T Dud,
Remove- -- . i C r-t LC UN R + R c tolort-L- 624 14 1)E-t.i. pi° d'it-/(1).
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ccl) I;
Submittal Fee $ t'
Notary $ Training/Education Fee $ &C 60 Technology Fee $ Nr t
Scanning $ e- Radon $ Zoning
Code Enforcement $
Permit Fee $
***********F ees*********************;***** **
/00 CCF $
CO /CC
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)
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. Also, a certtfzed 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 appro //ed and a ygnspection fee will be charged
Signature
0 e or Agent
The fo = ,oing instrument was acknowl-dged before me this
day ,
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,� =v who
onall kn
Signature
The fore •ng ins ent was acknowle
ita
11141
o has produced
who is p
rsonally known to me
before me this
o ho has produced
As identification and who did take an oath.
entification and who did to oath.
NOTARY P NOTARY PUBLIC: S. Y LI /�
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My Commission Expires: / °�'' . /,ir 4o•,omg " 9�0 y Commi3 n -Expires:
V r.. gm,,R`1 IYIk ' `J
APPLICATION APPROVED BY:
chc 05/13/03
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******************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
aR292t
Plans Examiner
Engineer
Zoning
1
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 5/12/2005
Building Permit
Permit Number: BP2005 -581
Page 1 of 1
Applicant: NOEMI GARCIA
Owner: GARCIA NOEMI
JOB ADDRESS: 10430 NE 3 AVE
Contractor
Local Phone:
Parcel # 1121360130450
Contractor's Address:
Legal Description: MIAMI SHORES SEC 5 PB 10-47 LOT 1 & E1/2 OF LOT 2 BLK 120 LOT SIZE
Fees: Description Amount
FEE2005 -5937 Building Fee $100.00
FEE2005 -5938 CCF $1.80
FEE2005 -5939 Training and Education Fee $0.60
FEE2005 -5943 Notary Fee $5.00
FEE2005 -5944 Technology Fee $2.50
FEE2005 -5945 Scanning Fee $6.00
FEE2005 -5947 Submittal Fee ($50.00)
Total Fees: $65.90
Total Fees: $65.90
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 10/19/2005 Construction Value: $2,500.00
Work: REMOVE EXISTING KIT AND INT WALL REMOVE CERAMIC TILE IN BATHROOM & FLOORS REMOVE DRYWALL CLA IN DEN
Signed: (INSPECTOR)
In consideration of the issuance to me of this permit, I 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:
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