BP-03-1132Miami Shores Village
4 Building Department
BUILDING
PERMIT APPLICATION
FBC 2001
RECEWED
JUL1 0 2003
10050 N.E 2nd Avenue
W-MiamLS)wres,---jYF orida 33138
e : 5) 795.2204
Fag: (3 5) 756.8972
Permit No. U903 '11,3v,
Master Permit No.
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) DRQ f2 j G e -'h , 5A' jr �!; Phone # (30S-) 89,:Z OS -10
Owner's Address lasib kyr . 1619"M
CityMjA.l►'IA ,TknaeS ETC State Ej. ,Zip as 11�- �®
Tenant/Lessee Name Phone #
Job -Address (where the work is being done) -TAW r �•
City Miami Shores Village County Miami -Dade Zip.'.S"�%
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's Address
City
Qualifier.
Phone
State Zip
Aj
Architect/Engineer's Name (if applicable) rlja .thole
Architect/Engineer's Address
City _
State
Zip.
$ Value of Work For this Permit k 00 / Square Footage Of Work:
Number of. Bays Stories Families Bedrooms Baths
Type of Work: []Addition ❑Alteration ❑N,,e�w ❑ Repair/Replace ❑ Demolition
Describe Work: 104 &)Q- G)( too .spo � i`^ Ati
,,1l�,�,�,�,�,�,�,�,�,�,�**,�;�,�,�,�*�,�*,Fees*,��*,�,�,�,�,�,�,�,��,��r,�,�,��,��,�,�*,r,�,��*,�
County Escrow Fee $ Q 6 V Permit Fee $ Notary $ �, d
Education/Training Fee $ Tech $ Scanning $ Radon $
Code Enforcement $ Bond $ Struct. $
Minus Plans Check Fee $ Total Fee Now Due $ to 14 /` (Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
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 installationss -iiindicated. 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 to the issuance of a building permit with an estiJk"airlue exceeding $2500, the applicant must
promise in good faith that d =r opy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certifted 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.
alp. Itl _ V-477
Signature,
Owner or AgentContractor
The foregoing instrument was acknowledged before me this The fore.�rr �ainstrument was acknowledged before me this
day of _.3 Qj 20�, by SG® day of . 20 —, by
who is perso known to me or who has produced who is personally known to me or who has produced
Ckb7-15 a As identification and who did take an oath. as identification and who did take an oath.
NOTARAMLI P X" A V#7 NOTARY PUBLIC:
Sign:
Print:
My Commission E;
DD091094
PAA COMMISSION EXPIRES
3 Sign:
Print:
My Commission Expires:
driraric&ztdrit�k4r4t9r9eit�tnYii3e�kieir4e4r4ria3r�r4eie3e4riYaYifi3e*irnk8eicir&
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
APPLICATION' APPROVED BY: //C�
chc7/7/03
JUL 14 2003 Plans Examiner,
Engineer
Zoning