MC-04-119 (2)iami Shores Village
`Vg p uildin Department
1
1 050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2001
Permit No. G O l
) 9
Master Permit No.EP 0 Y ! 3
Permit Type (circle): Building Electrical Plumbing Mechanic
Owner's Name (Fee Simple Titleholder) %x%12 J;�k_ 141111X-lWhone #
Owner's Address /ZCJQ NL 9!q 6IIE
City,�ml 51am3 State '/ zip/c3
Tenant/Lessee Name Phone #
Job Address (where the work is being done) BZW Nc ff
City Miami Shores Village County Miami -Dade zip �3 /
Is Building Historically Designated YES NO Al_�
Roofing
Contractor's Company Name :UC &",e ✓. OF 6Chj , . Phone # LWA.O
Contractor's Address c15FLt /_/
City %Ti
Qualifier 4
Zip
State Certificate or Registration No.OA:�Certificate of Competency
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit 40 /1 q0C) • _1
Type of Work:
Describe Work:
❑New
Phone #
Square Footage Of Work:
❑ Repair/Replace
❑ Demolition
00 e.
Submittal Fee $. S 1) Permit Fee $ CCF $ D CO/CC
Notary $ Training/Education Fee $ Technology Fee $ o .
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $ —5 q,j l)
(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 sits
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 approyod and a reinspection fee will be charged.
Signature /'
O r or Agent
The f r go' tnunen peimowledged b fore e s
day 20 by ,
who is personally kno twn t who has produced
Contractor
The foregoing instrument was acknowledged before me this o
day of 20 Y by A *--01 / A 0
who is personaLjFnown to me or who has produced
fAs identification ti�anndd who. ake an oath. as identification and who did take an oath.
NOTARY eomrrdssion 01)129,952 NOTARY PUBL .
Sign: pwe8 Ju313 .200 Dolores Imbert
Sign: RES
Print: June 14, 2006
r
My Commission Expire n My Commission Expires: SU �o , t �F t 'c�-D C� C0
.........
APPLICATION APPROVED BY:� Plans Examiner
Engineer
Zoning
Cho 05/13/03
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305-795-2204
Printed: 7/16/2004
Applicant: MARCELO
Owner: LEAL
JOB ADDRESS:
1250 NE 94
Mechanical Permit
Permit Number: MC2004-119
LEAL
MARCELO
ST
Page 1 of 1
Contractor BLUE WATER POOLS OF SOUTH FLORIDA Contractor's Address: 13771 N. GARDEN COVE CIRCLE
Local Phone: 954-473-1741
Parcel # 1132050100200
Legal Description: MIAMI SHORES BAY VIEW PB 40-16 W35FT OF LOT 21 & E65FT OF LOT 22 LOT
Fees:
Description
Amount
FEE2004-7051
Building Fee
$100.00
FEE2004-7052
CCF
$1.20
FEE2004-7063
Training and Education Fee
$0.40
FEE2004-7064
Technology Fee
$2.50
Total Fees:
$104.10
Permit Status: APPROVED Permit Expiration
Work: HEAT PUMP
Signed:
1/4/2005 Construction Value: $1,400.00
(INSPECTOR)
Total Fees: $104.10
Total Receiptsr 0.00
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict
conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY: