BP-05-957Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2001
Permit No.b
Master Permit No.
Permit Type (circle): Buildin _ Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder Y (( ?�- ) ( Phone #
Owner's Address D 4 '72O c 4-o (�-
City ?State
Zip --))3 r;8
8
Tenant/Lessee Name Phone # V ? q6
Job Address (where the work is being done)
City Miami Shores Villa • e County Miami -Dade Zip
Is Building Historically Designated YES NO %c
Contractor's Company Name OD 1 TTL!( T(bJ ICFe, Phone # 2� 7qt, 00, Co
Contractor's Address '710ll 7215 D
City 01 f WA-A I State Zip 3C-
Qualifier 4 ( iJ
04 -56
State Certificate or Registration No. (-17C- 3 t_ 8-47 Certificate of Competency No.
Phone #
Square Footage Of Work:
Architect /Engineer's Name (if applicable)
$ Value of Work For this Permit
Type of Work: Addition teration [New
Describe Work: y`I L-W \&T r■ c t 47 1
❑ Repair/Replace ❑ Demolition
* * * * * * * ** ** * * * **** *: *w** ** Tees * * * *** * * * ** * * * * * * * * * * * * * * * *:r **
Submittal Fee $ Permit Fee $ / 0 CCF $ 1- CO /CC
Notary $ 5.00 Training/Education Fee $ 0 GO Technology Fee $ Z.5
Scanning $ 3 • Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $ 1 f 2
(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 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.
Signature Signature 1
Owner or Agent Contracttor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknow}edgedd befoore me this
day of , 20 , by , day of , 20 , by V LC l.( / PCjy ),l.
who is personally known to me or who has produced who is personally known to me or who has produced ?0,
0,
As identification and who did take an oath.
/a/Side tification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign:
Sign:
Print: Print: �r
My Commission Expires: oFF� °� ��ndc� �,;,a
P My Commission Expires: ; �ndinr ,
****************************************** * * * * * * * * * * * * * * * * ** * * * * * * * * * * * ** ** * * * *** * * ** ** * * * * * * * * * *. * *,; * * **
APPLICATION APPROVED BY:
Chc 05/13/03
Plans Examiner
Engineer
Zoning
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 7/13/2005
Building Permit
Permit Number: BP2005 -957
Page 1 of 1
Applicant: RENE LEONI
Owner: LEONI RENE
JOB ADDRESS: 10430 NE 3 AVE
Contractor CONSTRUCTION DEPOT
Local Phone: 305 - 573 -6060
Parcel # 1121360130450
Contractor's Address: 578 NE 99 ST
Legal Description: MIAMI SHORES SEC 5 PB 10-47 LOT 1 & E1/2 OF LOT 2 BLK 120 LOT SIZE
Fees: Description Amount
FEE2005 -9488 Building Fee $100.00
FEE2005 -9489 CCF $1.80
FEE2005 -9496 Notary Fee $5.00
FEE2005 -9503 Training and Education Fee $0.60
FEE2005 -9506 Technology Fee $2.50
FEE2005 -9511 Scanning Fee $3.00
Total Fees: $112.90
Total Fees: $112.90
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 12/25/2005 Construction Value: $2,500.00
Work: NEW KITCHEN CABINETS
r JUL 1 5 PAID
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:
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 7952204
Fax: (305) 756.8972
Permit No.
Job Name
BUILDING CRITIQUE SHEET
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