BP-05-720BUILDING
.Miami Shores Village
Building Department
1.0050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305)295.2204 Fax: (305) 756.8972
row 0w
Permit No. 1,05 '_7
MAY �
PERMIT APPLICATION -- -- ' u v"M-s er Permit No:
I'BC 2001..,
Permit Type (circle)• Building Electrical Plumbin Mechanical Roofing
Owner's Name (Fee Simple Phone # 3�oS -7 - <
Owner's Address 3 _3 • 65 T 3 5
City
Tens
Job Address (where the worst is being done) 3 5 /P�g . IS §J
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO %
��i�e`rmA t DA'`�►/�- • 4�7 X212
Contractor's Company Name &"ZC ,626 mem_ ���/�_T_ Phone 4 fo?� l _Zra %%J L
Contractor's Address - // Z /1000
City AWA -2 L42 l
Qualifier���
State Certificate or Registration No. ell-25k�o
Architect/Engineer's Name (if applicable)
State r Zip
$ Value of Work For this Permit ' 21e�(at)
Type of Work: Addition ❑Alteration
Describe Work: Rw#'3,4f,,9dr' VI X i
of Competency No.
Phone #
Square Footage Of Work:
V ; Q 'Rvpair/R'epl, o
❑ Demolition
i
Submittal Fee $C,0 Permit Fee $ CCF $ CO/CC
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $
l
Code Enforcement $
Total Fee Now Due $
(Continued on opposite side)
IV
Zoning $ D • e� Bond $
Structural Plan Review. $ S `C f f) f
Bonding Company's Name (if applicable) 141
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 a charged.
Signature.
Owner or Agent
The foregoing instrument was acknowledged before me this ��
day ofOPH_, 2009 by R®b�%Iul ��1D
o is personally known o me or who has produced
NOTARY
a
As identification and who did take an oath.
MONICA MEDINA
Notary Public • Slate of Florida
OPSignature
d
Contractor
foregoing instrument was acknowledged before
`>m®e�this
9f 20 0 rby���
�77
na y own
to or who has produced
as identification and who did take an oath.
NOTARY P LIC:
f' > ``' . Shawn Hassell
S • "'` 4. • 6 "I
morn" �, l :, A;= Canmission q DD183224 _ = ' ° :e` Expires: Feb 11 2007
Print: BwIft By ;'�. o.
1s •OP F�
''��.��`Atlantic Bonding Co., Inc.
—ended Thru
M Commission Expires: My Commission Expires:
APPLICATION APPROVED BY:
chc 05/13/03
Plans Examiner
Engineer
Zoning
(A-11,