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BP-05-897Nit Shores feneA A_ - -_ Ce _ _perml- 10)_E WO 2" Alit and haVe th nod- 12Iea 1rcel work. Miami Shores Village Building Department 10050 N.E.2nd A-venuea iami Shores, Florida 33138 Tel: (005)0x 20 Iirats (3 )r ,'1:,.:ti d j BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle : Building Electrical Owner's Name (Fee Simple Tit e o .er) kek /IJr'I Permit No. &C/ 7 aster Permit No. Plumbing Mechanical Roofing Phone 47610A5e -55M Owner's Address 1006 NW ) °- citaktou &ties r=�. Tenant/Lessee Name N State Zip X 3 )5D Phone # Job Address (where the work is being done) City Miami Shores Villa e Is Building Historically Designated YES Contractor's Company Name l©5) 8 &f lu d 4 County Miami -Dade Contractor's Address City Qualifier NO Phone # Zip 3)5O State Zip State Certificate or Registration No. Certificate/of Competency No. Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit Square Footage Of Work: Type of Work: ❑Addition ❑Alteration $ew Describe Work: 5 f J den " let (f'CQ if ❑ Repair/Replace Kt4, p4api,5 Demolition * * * ** * *** * * * * * * * * ** ** * * ** ** Fees * * *, * * * * * ** * *** * * * * * * * * * * ** * ** Submittal Fee $ Permit Fee $ Notary $ 5- 00 Training/Education Fee $ Scanning $ 3 .00 Radon $ Zoning CCF $ i - a0 CO /CC Technology Fee $ 5 • 20 Bond $ Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ l s (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. Owner or The foregoing instrument was day of At , 20 by who sonally �wnIto me or wh Signature Contractor The foregoing instrument was acknowledged before me this day of ,20,by who is personally known to me or who has produced identification and who did take an oath. as identification and who did take an oath. NOTARY PUB !IC: NOTARY PUBLIC: Sign: Sign: Print: : i` '4, Mabel Vci ' as Print: ommission :DD231984 My Commi sion Exp ties: Q `Expires: Ju 3, 2007 My Commission Expires: * * * * * * ** * * * * * * * ** ,� * *; 4115****************,** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** /' iIantic Bonding Co.. Inc. APPLICATION APPROVED BY: chc 05/13/03 * * * * * * * *I * * * * ** '** ** * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ePlans Examiner Engineer Zoning