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PL-05-145Miami 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 Type (circle): Building Electrical Owner's Name (Fee Simple Titleholder) /`t2`/C-- Owner's Addr e ;3/67 /& f 41 „, //41/111.108X City State L 1/1 Tenant/Lessee Name Job Address (where the work is being done) City Miami Shores Villa:e County Miami -Dade Is Building Historically Designated YES NO A,„, Contractor's Company Name 764/4-/S G£ SA°(M..,k /E.&S/ bide Phone # Contractor's Address / 77 L%/ NL ,? t' City /t /A / ( State 17,4 Qualifier 2 ? 'Selz T pc) s RECt VtD MAY 1 0 2805 Permit No. og._ /4L Master Permit No. '"c "' G Cr 15tv4 Mechanical Roofing #.50 °/2 Phone # Zip Phone # (TN 525- c792- YS• O AG& fie. Zip 3 ©s-- s766-9.25- Zip —3 3 State Certificate or Registration No. Certificate of Competency No. ®O © ©D 2 i� # 7- Architect/Engineer's Name (if applicable) Wet fi4L-dez Phone # $ Value of Work For this Permit Type of Work: ['Addition ['Alteration Describe Work: 2.. Square Footage Of Work: li,k(New ❑ Repair/Replace Z--,4w S Pxf Let „cy, s i ❑ Demolition * * * * * * * * * * * * * * * * ** * * * * * * * *F * * * * ** Submittal Fe Permit Fee $ /f° Cam-$-_ CO /CC Notary $ Training/Education Fee $ ' - 00 • Technology Fee $ 4 -50 Scanning $ `) -00 Radon $ Zoning Bond $ * * * * * * * * * * * * * * * * * * * * ** Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ 101 I.50 (Continued on opposite side) Bonding Company's Wain e (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 hi 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 inspectio a occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be. ipprov i1 # nd a reinspection fee will be charged. Signature Own ice The foregoin instrument wacknowledged before me this The foregoing instrument was acknowledged before me this day of , �/ , 20 IV , by esaig CB. day of „C",/,`19 , 20 by }1 7A Signature Contractor who is p sonally , to me or who has produced who is NOTARY PUBLIC: Sign: Print: My Commission Expires: As identification and who did take an oath. e�' Mn Schaffer NOTARY PUBLIC: � My Commissiac DD280181 fires .January 11.2008 te7 Sign: Print: o me or who has produced as identification and who did take an oath. MySusan Schaffer Commissbn DD280181 %et, Expires January 11, 2008 My Commission Expires: ******************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED B 144 d'1t . Plans Examiner irEngineer Zoning chc 05/13/03