EL-06-295Electri
9-L 7 76, c jd c
Zip
Phone #
BUILDING
PERMIT APPLICATIO
FBC 2001
Permit Type (circle): Building
Owner's Name (Fee Simple Titleholder) �'�p e #
Owner's dress A /
City
Ten . s t/Lessee Name
Contractor's Company N
Contractor's Ad i• ess 76 6 -
City
Job Address (where the work is being done)
City Miami Shores Village County fin -Dade Zip
Is Building Historically Designated YES
Qualifier
State
�0 �7 / M2 /
� � �
st L
State Certificate or Registration No. -f c30 / Z$
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit
Type of Work: ❑Addition
Describe Work:
Total Fee Now Due $
(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
1
['Alteration
REC V ED
FEB 3 % 0
NO
New
Submittal Fee $ ' Permit Fee $ Z 7 4.
Notary $ Training/Education Fee $ 2
Scanning . 00 Radon $ Zoning
Code Enforcement $ Structural Plan Review. $
Plumbing Mechanical Roofing
Certificate of Competency No. GP e:7 " -
Square Footage Of Work:
* * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * ** * * ** * * * * * * ** * * **** * * * * ** **
Permit No.. FLOG / " 2-Q -B
Master Permit No. Q U (, - 243
Phone #
❑ Repair/Replace ❑ Demolition
CCF $1:2/ C 7 CO /CC.
Technology Fee $ •
Bond $
NOTARY)
LIC:
Sign: / : I Print: My inmi Expires:
* * * * * * * * * * * * * * * **
APPLICATION APPROVED BY
chc 05/13/03
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
/ 2
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 Al1 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 '1_,74,_,
Owner or Agent Contractor
The for tru neptw acknowledg- a before e this The fore ument was acknowled ed befo a me this '
day of . Pi L L' '-=�� day of , 20 , by ' r,./ a,
who is personally known to me or w o I :iroiicisii
As identiy ion . who did take an oath.
r
Signature
who is personally known to me or who has produced
as identification and who di
NOTARY PUBLIC:
Sign:
Print:
My Co i i ion Expires:
c MY COMMISSION #D0361K2 ttY CC lSS ON I DD 3 6180 `
* EXPII ES: April 26, 2009 0 e %%PinES: April 26, 2009
oe +
'' wQttft PiM* $ lr ********** * * * * * ** * * * * * * * * * * * * * * * * * * * * * * ** *lam ** * * * :
Plans Examiner
Engineer
Zoning