BP-04-1627BUILDING
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
PERMIT APPLICATION
FBC 2001 ,,R, NA
Permit Type (circle)- `Building Ele
Owner's Name (Fee Simple Titleholder) l
Owner's Address
6 /V ® �®
M 9 r - 0
City
Tenant/Lessee Name
REMOVED
1 3 2004
Permit No.
Master Permit No.
-alPlumb'ff Mechanical Roofing
.PAMCC, JIMAone #
A
zip 3 3 •® 13, 3 L
Phone #
Job Address (where the work is being done) t q b Al, 'W p I ®3 rw <X— -
City Nfiami Shores Village County Miami -Dade _zip
Is Building Historically Designated YES NO
Contractor's Compa
Contractor's Address
city��g2,,u�, zip �I 3�
Qualifier s ��% e' lV�CU'lI-e-f
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
N C ,
S Value of Work For this Permit)L Footage S Ware a Of Work:
� g
Type of Work: (]Addition ; FlAlterqtion New ❑ Repair/Replace, Demolition
Describe Work:
r(407
�h
Submittal Fee $` Permit Fee $ CCF $ CO/CC
Notary S Training/Education Fee $ Technology Fee $
Scannings Radon S Zoning Bond S
Code Enforcement S — — Structural Plan Review. $
Total Fee Now Due $
(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
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.
Signature 16� 1� Signature
'U
Owner or Agent Contractor
The foregoing instrument was ackno/ ledged`be��fore me �'s 13 The foregoing instrument was acknowledged before me this
day of L 20 �, by W" I �l �,�11'� day of .20 _, by ,
who is personally it%�n to me or who has produced who is personally known to me or who has produced
As identificatfWdfch�(a�'�yS _ as identification and who did take an oath.
- ��"��TOTARY PUBLIC:
NOTARY P LI ° `* Expires• Jeal 1 3� �()Q
Sign: 1 fir. Sign: i
-
Print: y " Print:
My Commi sionExpires: u ��'��r c' t"�� , 3.2007 My Commission Expires:
APPLICATION APPROVED BY:
Chc 05/13/03
12-5 b Plans Examiner
Engineer
Zoning