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BP-05-1521 Olt Miami Shores Village Building Department i 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:( VE } 8972 BUILDING OCT 1 B5 Permit No. AO PERMIT APPLICATION aster Permit No. FBC 2001 Permit Type(circle): wilding Electrical Plumbing Mechanical Roofing 4Owner's Name(Fee Simple Titleh der) _© N M L /'1- pQone# (306)� 'CpG C Owner's Address Bed I CityN I CYrn i 51-)0 1 . zip -&3 13 Tenant/Lessee Name Phone# Job Address(where the work is being done) S990 Cc'k-j City Miami Shores Village County Miami-D de zip Is Building Historically Designated YES NO Contractor's Company Name C>,-� �- Phone# Contractor's Address City State Qualifier State Certificate or Registration No. Uof Competenc No. Architect/Engineer's Name(if applicab a Phone# $Value of Work For this Permit Square Footage Of Work: Type of Work: EIA ion A lteration ❑New ❑ R air/Re ep place ❑Demolition Describe Work: Submittal Fee$ Permit Fee$ , • CCF S Q, `oC7 CO/CC Notary$-75- Training/Education Fee$ G Technology Fee$ ( --S(7-) Scanning$ Radon S Zoning Bond$ Code Enforcement$ Structural Plan Review.$ Total Fee Now Due$ (Continued on opposite side) Bonding Company's Name(if applicable) 4 Bonding Company's Address , City State Zip r j 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 attachmep Iso, a certified copy o e recorded notice of commencement must be posted at the job site for the first inspection which oc s seve (7) days after a building permit is issued. In the absence of such posted notice, the inspection will not be approved nd a rei ection fee be charged. Signature Signature Ow or Contractor The for oioinginstrument w owledged before me this The foregoing instrument was acknowledged before me this day ofT � 20 CE5by,�nh j'l M 1 l 1 -VCA Qday of 20 by who is personally known to me or who has produced who is personally known to me or who has produced 1'�O • As identification and who did take an oath. as identification and who did take an oath. NOTA Y UBLI : NOTARY PUBLIC: Sign: Sign: Prinission DA Print: My Expires: &pires. S 2 5 My Commission Expires: Bonded APPLICATION APPROVED BY: /D / y J PIans Examiner Engineer Zoning chc 05/13/03