BP-03-1923Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fag: (30756.8972
ECQ �A E
BUILDING. aEC 200
PERMIT APPLICATION i asti
FBC 2001 mmmW- ®-p
Permit No. P) 1" Q3 — 19 �L-3
Permit No.
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) �_- Phone # ®�
Owner's Address t LE k 1 O l
i� State FL' Zip l
Tenant/Lessee Name Phone #
Job Address (where the work is being done) `-F l t a.3 �-:z l0 t S'V
City Miami Shores Vfllage County Mann Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name 0 w w M Phone #
Contractor's Address
City.
State ^— , Zip
Qualifier
Architect(En ' eer's Name if applicable) ( Phone #
S'm ( aPP )
$ Value of Work For this Permit Square Footage Of Work:
Type of Work: ❑Anddition ❑Alteration [--]New❑ Repair/Replace El Demolition
Describe Work: 1 °-t •-' ` �.1t-``� 2`-o bz_. (`" " `_ C
Submittal Fee $ Permit Fee $%(� 0 CCF $ -(00
Notary $ �' U U Training/Education Fee $ Technology Fee $
Scanning $ Radon $ Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $�,in `. t t
c -0-- 0 23(10
(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
Zip
R -
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 EMPROVEMENTS 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 ch*
ODL
SAN'
Signature Signature
Owner or Agent
The foregoing instrument was acknowledged before me this LIQ—
day of �1 , 20 0'3, by i�mO A 9. 1 nerl 6 ey�t
who is personally known to me or who has produced_ekqjb 14
As identification and who did take an oath.
NOTARY
Sign: _
Print: 02.1
My Commission Expires:
State Certificate or Registration
APPLICATION APPROV
Chc 10/14/03
Contractor
The -foregoing instrument was acknowledged before me this
tray )f , 20 by
who is personally known to me or who has produced
as identification and who did take an oath.
Vama@ NOTARY PUBLIC:
Sign:
Print:
Co., Inc.
My Commission Expires:
(Certificate of Competency Holder)
Certificate of Competency No.
/J
> Examiner
Engineer
.Zoning