BP-04-1588 r Miami Shores Village 4 4
WTIIOUrW� Building Department
10050 N E.2nd$ue ores,Florida 33138
0' 5)7 56.8972
BUILDING DEC, Q 2004 Permit No. 00®t/
PERMIT APPLICATIO , c _ m - Master Permit No.
FBC 2001
Permit Type (circle): Buildinglectrical Plumbing Mechanical Roofing
r l
Owner's Name(Fee Simple i GLCc, 1rQ/1.L' Phone# -�--3G =cj 6
Oer's ddress '�' �� cl
Ci 6-CUU-t. State Zip / 3
Tenant/Lessee Name Phone#
Job Address(where the work is being done) (e off'— C, `-7A —
City Miami Shores Village County Miami-Dade Zip 9 }
r--
Is Building Historically Designated YES NO�
` 7
Contractor's Company Name Phone#
Contractor's Address
City
Qualifier
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name(if applicable) Phone#
$Value of Work For this Permit m , Square Footage Of Work:
Type of Work: ❑Addition ❑Alteration ❑New air/Replace ❑Demolition
Describe Work:
' f AA ACT— c".LA
® _A/
1
Ar19,lit **Fees*********
Rol
Submittal Fee$ Permit Fee$ tea® CCF$ 3j CO/CC
Notary$_� Training/Education Fee$ /I Technology Fee$ ��
Scanning$ Radon$ Zoning Bond$
Code Enforcement$ Structural Plan Review.$
Total Fee Now Due$011-0
(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
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 a roved and a reinspection fee will be charged.
Signature Signature
Owner or Agent ``�( Contractor
The foregoing instrument was acknowledged before me this 3 fLtne foregoing instrument was acknowledged before me this
day of 1 by ✓�s`U--eA� day of, .20 by ,
w • personally known to me r who has produced who is personally known to me or who has produced
i entification and who did take an oath. as identification and who did take an oath.
NOTARY PUB C: NOTARY PUBLIC:
�•t°s`rP�o g -H. �3onelt
Sign ° e triCommisslon
Print. ` 0A,�U2s - `iaQ ExpiPasniUlay 26,2008
06 wo, Bonded Thru
� � � � �
AUar
My Commission Expires: y� bm Expires:
APPLICATION APPROVED BY: f V�j\®� Plans Examiner
Engineer
Zoning
Chc 05/13/03
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
OWNER BUILDER DISCLOSURE .STATEMENT
I 4 C4� V Z'0l being the legal pro erty owner, for the property
Located at:
Legally described as
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the
State of Florida,F.S.489.103(7),,4nd I have read and understand the following disclosure
Statement, which entitles me to'Mork as my own contractor, I further understand that I as the owner
must appear in person to complete all applications.
DISCLOSURE STATEMENT
State law requires construction to be done by licensed contractors. You have applied for a permit under an
exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor
even though you do not have a license. You must supervise the construction yourself. You may build or
improve a one-family or two-family residence or a farm out-building. You may also build or improve a
commercial building at a cost of$25,000.00 or less.The building must be for your own use and occupancy.It
may not be built for sale or lease.If you sell or lease a building you have built yourself within one year after the
construction is completed, the law will presume that you built it for sale or lease, which is a violation of this
exemption.You may not hire an unlicensed person as your contractor.It is your responsibility to make sure
that people employed by you have licenses required by state law and by county or municipal licensing .
ordinances. Any person working on your building who is not licensed must work under your supervision
and must be employed by you, which means that you must deduct FZ.C.A. and with-holding tax and
provide workers' compensation for that employee, all as prescrn`bed by lay. Your construction must comply
with all applicable laws,ordinances,building codes and zoning regulations.
Proof of ownership provided( ) initial of reviewing clerk.Tlie foregoing instrument
Was acknowledged before me this �ay of_ 20
`~ V Qin
By � ho is personally known to me or ho has
Produced as identification and who did take an oath.
et 0
Owner
Oinny H. Gonell
Commission#DD323870
Expires-May 26,2008
�•OF F`or: KiZd TI. .
Atlantic Bonding Co.,Inc.