BP-04-1084 (2)Miami Shores Village
Buil in D
d art
e ment
g p N I 1 7 2066
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fag: (305) 756.8972 Y: __
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.
FBC 2004
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) ?)-C)6 b 1 �ers. Phone # � d 5 1 q V 5 & -I7
Owner's Address 4401 �AE t 0 i ST
City -1 1 Q Y l -tti�€ State
TenanVLessee
Job Address (where the work is being done)
Zip ---s --�6 1
Phone #
1401 14E ibi ST
City Miami Shores Village County Miami -Dade zip 7�> 3 3 �7
FOLIO 1 PARCEL #
Is Building Historically Designated YES NO
Contractor's Company Name PROrAPP. Phone # - `S 4- C1 ? O2y
Contractor's Address 5 add W 2 Awe
Ci ty FT. LAWGRbake state F L zip °33309.
Qualifier Name AeT�� Phone # 3V5
State Certificate or Registration No.
Certificate of Competency No.
Architect/Engineer's Name (if applicable) t. Phone #
Value of Work For this Permit $ �3 .2 1
eZ S
Type of Work: ❑Add�it+io/n ❑Alteration
Describe Work:
Square/ Linear Footage Of Work: I-001 Sa�-
7� CIGe-�
❑ Demolition
Submittal Fee $ Permit Fee $ 7) CCF $ CO/CC
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $,
DPBR $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $
Zoning $
Total Fee Now Due $
See Reverse side
Bonding Company's Name (if applicable)
Bonding Company's Address
City State zip
City State 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 EMPROVEIVIENTS 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 esti ted value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lie law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice ocomm cement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issue � In t e absence of such posted notice, the
inspection will not be approved and ea pection fee will be charged
I t�i
'
Sigr►ature a Signator
Owner or Agent
The foregoing instrument
was acknowledged before me this
day of V6r 2( --,by
who;onall to me or who has produced
As identification and who did take an
NOTARY PUBLIC:
Sign:/�/,�_
Print: !`tUoat
My Commission Expires:
APPLICATION APPROVED BY:
(Revised 02/08/06)
Contractor
The foregoing instrument was acknowledged beforemethis
day of Uv 20(x, by /�/(lSldY Ar�iDV I���� ,
who is personally known to me or who has produced rX ptud t Ic
/� -�(� 2-6)3'5"13as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My C
Plans Examiner
Engineer
Zoning