ME-03-218 ,EcEizEn Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores,Florida 33138
Tel:(305)795.2204
Fag:(305)756.8972
BUILDING Permit No. )03'22 I
PERMIT APPLICATION Master Permit No.
FBC 2001
Permit Type(circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder) \�(e)�� \$ Phone#
Owner's Address N C>0X\N E�o� -,®-3
State Zip
ty
Tenant/Lessee Name Phone#
Job Address(where the work is being done) \l13 N��- �-° \0-6 " 5�
City Miami Shores Village County Marro Dade Zip
Is Building Historically Designated YES')(,- NO
Contractor's Company Name (a7X�� �— Phone#(3®�
Contractor's Address ®� �'® -30 -11`�1-
State
Zi
City � ^ p
Qualifier
Architect/Engineer's Name(if applicable) f 9 . Phone 4
Architect/Enginneer's Address Jn
$Value of Work For this Permit 4- Square Footage Of Work:
Number of.Bays Stories' Families Bedrooms Baths
Type of Work: []Addition ❑Alteration []New Repair/Replace ❑Demolition
Describe Work:
County Escrow Fee$ Permit Fee$ /® Notary$
Education/Training Fee$ Tech$ Scanning$ Radon$
Code Enforcement$ Bond$L_ Strict-$
Minus Plans Check Fee$ n 0 Total Fee Now Due S (Continued on opposite side)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
CityState 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 Il"ROVEMENTS 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 i Signature
r
Owner or Agent on for
The foregoing instrument was acknowledged before me thisfo ' , g instrumen acknowledged before me this
day of 1 . . 20 q ,by dao 2003,by
who is personally known to me or who has produced who is personall own tom r who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY P IC: NOTARY PUBLIC: ,��y- oM E Es LUIS
r OREMESLUIS
ape _: ��'-= MY COMMISSION II DD 173698
Sign: : ac_ MY COMMISSION#DD 173698 Sign:
r eea nw ram�v POW underwrUere
Print: P-��'a % nw icy u,menvraere Print: ® � ' ^�`
My Commission Expires' My Commission Expires:
(Certificate of Competency Holder)
State Certificate or Registration No. C' ��3}� Certificate of Competency No. < �� y
************************************************************************************************************
APPLICATION APPROVED BY: � �� C �' "� �e-��` Plans Examiner
Engineer
Zoning
Chc 10/02/03