BPP-06-243f
BUILDING
PERMIT APPLICATIO
FBC 2001
Permit Type (circle): uild' - ;c v
) g /'' , e a Plumbing Mechanic Roofing -
Owner's Name (Fee Supple Titleholder) - -�"tL= - NJ 0 Phone # 3�Z —
Owne 's Address `"_ 1 S� -
City (i'M� Zip 33 �
Tenant/Lessee Name — Phone #
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
$ Value of Work For this Permit
Total Fee Now Due $ 1 1 .
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
14ECEOVED
ik 006
l `0D
i -Dade
Contractor's Company Nat L..I —
Contractor's Address 1 Lo 1
City (A NA 1 State • Zip
Qualifier 1D=N 4 - 1 v-4Y
Permit No. FCYC) - 24:3
3
Master Permit No.
State Certificate or Registration Nog--- Z 6 ! Certificate of Competency No.
Architect/Engineer's Name (if applicable LA l 4 D Phone #(
Square Footage Of Work: a 1.42. 4—
Type of Work: Addition ['Alteration ['New ❑ Repair/Replace
y� ' �
❑ Demolition
Work: t. L' , L rvi t ll L 7"�
_
--dam 3 * * *** * *** * * * *** * * * * *, * * * ** F * * ** * * * * * * **** * * *** * * * * * **I ***
Submittal Fee $ O Fee $ 5-70 u� J 1 - 40 N CCF $ CO/CC .i SC)-
Notary $ Training/Education Fee $ 3. t)O Technology Fee $ 1 a
Scanning $ (QO. 00 Radon $ 0 • C r" + 1. H Zoning Bond $ 3(X—.
Code Enforcement $ Structural Plan Review. $ SO` OL>
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 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 oing instrument was acknowledged before me this
day of , 20 _, by 20 by
who is personally known to me or who has prod ) who is personally known to me or who has produced
As identification and dean 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 d fo Plans Examiner
Engineer
Zoning
chc 05/13/03