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BP-05-1253Miami Shores Village Buil ding Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (3 ���y��;- ��o-_ _ -- 756.8972 BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): A IM 1 2005 Electrical Permit No. ewe. Master Permit No. tz53 Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) linteret Phone # ( ) clg91 Owner's Address i 4 t4u aq 6tree-r City MO—MI &O W' L State Tenant/Lessee Name 1'..1 )ik Zip bbi �JO Phone # Job Address (where the work is being done) 4q &Veep City Miami Shores Villa e County Miami -Dade Zip V 50 Is Building Historically Designated YES NO Contractor's Company Name Cwoor Contractor's Address City State Qualifier Phone # Zip State Certificate or Registration No Certificate of,C ompetency No Phone # Architect/Engineer's Name (if applicable) $ Value of Work For this Permit nn Square Footage Of Work: Type of Work: ['Addition ❑Alteration IDNew ❑ Repair/Replace ['Demolition Describe Work: V.0 SLAK6CAL, (Ark p Q -■,•-- c r- 176 04- r * * * * *** * * *,� * *,� * * *,�,� * * * ** Fees * * * * * * * * * * *** * * * * * ** * * ** ** * * ** Submittal Fee $ Permit Fee $ Notary $ 5-CO Training/Education Fee $ 0. 2.0 Scanning $ 3• CO Radon $ Zoning CCF $ a © CO /CC Technology Fee $ Z • ) Bond $ 3C)f3 CC) Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ 4I! • 30 (Continued on opposite side) AUG PAID CllK 76 4 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 willyot be approved and a reinspection fee will be charged. Signature Owner or Ag The foregoing instrument was acknowledged before day of who is personall 20y Signature Contractor e this _ The foregoing instrument was acknowledged before me this it day of , 20 , by 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. wn to me or who has produced NOTARY Sign: Print: My Co ' ission Expires: * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: the 05/13/03 NOTARY PUBLIC: .., argas sign: onm1ission.' DD231984print ' . -4 ►,➢ es tu d 3, 2007 — vonded Tfitu My Commission Expires: ? kl�tttlC Bbtidift0 Co. 4ev r/-26-4 Plans Examiner Engineer Zoning Multitech Building Technologies, Inc. License Number: CGC060943 License Status: Active Licenses: Cert General Contractor Ref: 142 NW 99 ST. Miami Shores, FL. Safety inspection 6 ECEVVED AUG 2 "2 This is to certify that I have conducted an inspection at the above referenced property in order to confirm no work was done at this property for the following trades: Driveway Permit # BP05 -1253 Exterior paint Permit # PT07 -998 I fully understand that the City of Miami Shores Building Department will not perform any plan review or field inspections and that the Building Official will rely solely upon this "sworn affidavit" to close out these permits. 404,,.)b(,, Signature of Qu //alli�ifier Print Name CeQPpiC/© Ofd'. -S CIS State of Florida • Sworn to and subscribed before me this day of l" 201 • Signature o Print Na17te (SEAL) Personally known Or Produced identification •o -.fir, MELISSA RAMIREZ " Notary Public - State of Florida My Comm. Expires Feb 17, 2015 °%rF op; Commission # EE 65911