BPP-06-1737 Miami Shore it
s Village
c� 33 Buildin Department
�- Building p
P 10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:( 6.8972
BUILDING U 7 2006 Permit No.� ®� 1 -7 3 -7
PERMIT APPLICATION g ,_ _ ______ __Master Permit No.
FBC 2004
Permit Type(circle): uildin Electrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder) � iQ5��� Phone#���(�
Owner's Address�✓�(/c� .(>(� O� G Jt3/L�
City_4o14 tf.� S �712��^ State �- f Zip _J 3 f 3
Tenmt/Lessee Name Phone#
Job Address(where the work is being done) -2, C-0 y p-
City Miami Shores Village County Miami-Dade Zip 3/�
FOLIO/PARCEL#
Is Building Historically Designated YES NO�� •
Contractor's Company Name P 0 Z) C S Phone
Contractor's Address
City ,lie-ei�c t a S to
/� - S Zip-
Qualifier
Qualifier Name N
O
State Certificate or Registration No. (.XY (0(/9�4 Certificate of Competency No.
Architect/Engineer's Name(if applicable) t�j -�it�. (,(J ��� Le# •
Value of Work For this Permit$ ?�cPIDOI Square/Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration ew ❑ Repair/Replace ❑Demolition
Describe Work:
Submittal Fee$ .D"' permit Fee$ CCF$ SMO CO/CC
Notary$ 5CO Training/Education Fee$ Technology Fee$ —10, &S
Scanning$, �Q Radon$ DPBR$ Z •Q5 Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ ®rte Total Fee Now Due$
See Reverse side
Bonding Company's Name(if applicable)
Bonding Company's Address
r
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
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 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 be charged
Signature Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrumentwas acknowledged before me this
day of .20 by day of .20 by ,
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
My Commission Expires: My Commission Expires:
APPLICATION APPROVED BY: 7/3 Ot'/ GTi Plans Examiner
ell(//Ox,a Engineer
S Q Zoning
(Revised,02/08(06)
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date LO UA-CU Job Address--M MLI) L` 11� Tax Folio
Legal Description LbT-4 1 V1142 1I MaMKS yl! -
kstoncany Designated: Yes No
Owner/Lessee/Tenant GaxhI V( Master Permit#
Owner's Address Z Phone 3D5• Q-35-5315
Contracting Co. r-AAddress 13M SLO 1 1STi*'1O0
Qualifier yac SS Phonca5 ;ES'5
315
State# 1.YL'0ao43q Municipal# Competency# Ins. Co.
Architect/Engmeer Address qM J ` I
Bonding Company Address.
Mortgagor Address
Permit Type(circle one): UILDING LECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
8 �I
Square Ft Lin Eiti/ st(value) Q.�l
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCENX YOUR FAILURE TO DO SO MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY(IF YOU INTEND TO G AIN FINANCING,CONSULT WITH YOUR LENDER
'OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above,and on the attached addendum(if applicable). I certify that all work
will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL
PLUMBING,SIGNS,POOLS,ROOFING and MECHANICAL WORK,
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 zonings Furthermore,I authorize the above-named contractor to dowork stated.
-6d �IA i -n aVW (
Signature Powner President Date Si ContraCtOr or Builder Date
otary as to t Notary as o blip 27E276 Date
Commissi JULIEM COII-D' Co L CpiresPMES:January 1.2008
my COMMISSION 9 Po 27wo 1 eoD3NOTARY H NOWY 06sr u Assoc.Co.
��av� EXPIRES:Jana"1.20M
- pom
14p �TARY R t�Y wwt co,
FEES: PERMPT RADON C.C.F. NOTARY BOND
APPROVED: TOTAL DUE
Zoning Building Electrical
Mechanical Plumbing Structural Engineer