FW-7-1410Miami Shores Village
Buildin g Department artment 011
I
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 1J .
Tel: (305) 7952204 Fax: (305) 756.8972
nom of. 441,
BUILDING 1PCMg7F-11 Permit No. ho 1:0
PERMIT APPLICATION MI JOE 0 6 2001 aster Permit No.
FBC 2001
BY:_. f,_: °e
Permit Type (circle): Building ) Electrical Plumbing Mechanical Roofing
Owner's Simple Titleholder) ?a jpt : 12,97/C, Phone # �%a l - .47 i 3
Owner's �Adddress II/ 4 .
City dv '- G A.lr ij J5h r ,5 State d-- Zip ` 1
Tenant/Lessee Name Phone s �° p % 2)
Job Address (where the work is being done) L'? y' . /D II. Z-1,2--11,/et x- (
City Miami Shores Village County Miami -Dade Zip ""7-7/"2-7.€2(
Is Building Historically Designated YES NO }<
l
Contractor's Company Name G I 007 � Pd e #T t d
Contractor's Address
City
Qualifier
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit
Phone #
Type of Work: ['Addition ['Alteration
Describe Work: e 1 1111t-
New
1 ' i
Square Footage OfWorJ: 't
z2P7 71�
New ! Repair/Replace / D Demolition
* * * * * * * * * * * * * * * * * ** *** *Fees * * * * * * * * * **
* * * * * * * * * * **
Submittal Fee $ Permit Fee $ �D CCF $ ) 0 CO /CC.
Notary ry $ Training/Education Fee $ �
0 Technology Fee $
Scanning $ q ® Radon $ Zoning Bond $
Code Enforcement $
Total Fee Now Due $ I 1 a • 3U
Structural Plan Review. $
(Continued on opposite side)
oPAIf
OLosto
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 y einspection fee will be charged.
Signature `'
Owner or Agent
The foregoing instrument was acknowled
day ()P .-3u , 20C' by
who ' personally known to m or who has produced
As identification and who did take an oa
Signature
Contractor
The foregoing instrument was acknowledged before me this
6iayof ,20 ,by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLI
Sign:(
Print:
My Commission Exp
* * * * * * * * * * * * * * * **
GARY PUBLIC:
Sign:
Print:
My Commission Expires:
*************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
chc 05/13/03