BP-04-1565Miami Shores Village
Building Department C-tprw-J s"[3 t joy
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING RECEOVED Permit No. voocxv
PERMIT APPLICATION DEC r 2004 aster Permit No. .
FBC 2001
Permit Type (circle): 99�-,Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) r" [A°1"� Phone #��
Owner's}�-Address �� toe C 141
city—lbState Zip
Tenantd,essee Name Phone #
Job Address (where the work is being done)
City Miami Shores Village County Nami Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name Lf — Phone #
Contractor's Address J
City
Qualifier
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit :z
Type of Work:
Describe Work -
[]Addition
❑Alteration
❑New
Square Footage Of Work: _.
Repair/Replace
� *****F eS*'�**st�tea�rat�ee�c*+�rtxte��ros�sa����et�i�za�te�r
Submittal Fee $ Permit Fee $ C G -� CCF $ '
Notary $r, Training/Education Fee $ t Technology Fee $
Scanning $ ^ Radon $ Bond $
Code Enforcement $ ��'^' 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 m compliancewith 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 pprg d and reinspection fee will be charged
Agent
The forego' iuy�lctune�ft t ack
day of
who s personally known to me or
X91141
Signature
Contractor
Vdged'' before me this The foregoing instrument was acknowledged before me this
y of 20 by
has produced who is personally known to me or who has produced
i and who did take an oath. pig as identification and who did take an oath
=:5 �YPLo , G��Orie1�IC:
�° `° = Commmiiis'ion #1 870
;•,
Exp res: May 26, 2008
Bonded T2d&-
Atlantic Bonding Co., Inc.
My Commission Expires: My Commission Expires:
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
APPLICATION APPROVED BY:
F1 — 2004 Plans Examiner
Engineer
Zoning
Chc 10/14/03