BP-05-1582BUILDING
PERMIT APPLICATION
FBC 2001
Owner's
City
Tenant/Lessee Name
Type of Work: ❑Additio
Describe Work:
Scanning $
Building Department
10050 N.E.2nd Avenue, Nfiami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (3 05 7 6.8972
' -
Total Fee Now Due $ 6 ' ao
(Continued on opposite side)
Miami Shores Village
Permit Type (circle). Building Electrica P umbing p¢elllnical Roofing
Owner's Name (Fee Simple Titleh 1 er 64 J - 2Z '' ' s 1 of ei f t Phone # /�
f
F7.0 l Zip 3 / ,3g
Phone #
d1r /O35
-4 State
Job Address (where the work is being done) /03 . k) 6
City Miami Shores Village County Miami -Dade Zip 33i S
Is Building Historically Designated YES NO
Contractor's Company Name Phone #
Contractor's Address
City
Qualifier
$ Value of Work For this Permit 4 [ 000
* * * * * * * * * * * * * ** * * * * * ** * ** ***Fees * * **
Submittal Fee $ Permit Fee S CO 9
Notary $ ■5 Training/Education Fee $ CD. �'�
Radon $
Code Enforcement $ Structural Plan Review. $
Permit No.
aster Permit No.
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Square Footage Of Work:
❑Alteration ❑New El Repair/Replace ❑ Demolition
* * * * * * * * * * * * * * * * * * * ** * **
,B6
CCF $ E - CO /CC
Technology Fee $ - 'CD
Zoning Bond $
Bonding Company's Name (if applicable)
Bonding Company's Address e
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 inspe , ion which occurs en (7) days after the building permit is issued In the absence of such posted notice, the
inspection will ' a approved and � spection fee will ' e charged.
vt iirAt /L..
Owner or Age t Contractor
The foregoing instrument was acknowledged before me this l 0 The foregoing instrument was acknowledged before me this
day of , 2� by ' R • m (.) M .iy'of , 20 _, by
who is penally known to me or who has produced: , '6 who is personally known to me or who has produced
Cho 05/13/03
APPLICATION APPROVED BY:
As identification and who did taker► oath. as identification and who did take an oath.
NOT ' Y 'UBLI , NOTARY PUBLIC:
. Sign: I ' �� Sign:
Print: • �`' ` * Print:
l.jT f ' f'
My Commi >sion Exp' j � i' l ' y My Commission Expires:
* * * * * * * ** , * * * Aon e4r • x41' iiii 11 �' . * * *, , *, * * * * * * * * * * * * * * * * * * * * * * *, * * ** * * * * * * * * * * * ** * * * * * **** *** * *e
****** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *, * * * * * * * * *,** ** * * * ** * * * * * * * *** * **** * * * *
Signature
iI
3
Plans Examiner
Engineer
Zoning
Date
•
Owner's Name
Owner's Address
• 1
65
Job Address (where the work is being done) /6(' ).
City Miami Shores Village County Miami -Dade Zip 3 - 3 / 2 D
Is Building Historically Designated YES NO . x
Contractor's Company Name (if applicable) Phone #
* * * * * * * *; * * * * * * * * * * * * * * * * * * * * * * * * *i* * * * ** ******************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
is on the site must be List d and , dice --' -° `°'' ` "'
Walls
Fascia
Drip Cap /drip Edge
Soffit Cic:36-
Miami Shores Village
Paint Color Approval and Agreement
Roof
Flower bins
Shutters
Awnings
Chimney 1 ��
Doors and door jams I
Garage doors
Railings
Fences
Decorative metal
All brick (simulated or regular)
Stucco banding
Any other stucco features
Accessory Buildings
Signature
(2 6 1"--e_4 l r9 • / u44 - Phone # 3 r/7 6 .2- /
330,5
State -- Zip (5�
APPLICATION APPROVED BY:
P& Z Official
SW 6618
Cosmetic Peach
SW 6619
Sockeye
SW 6622
Hearty Orange
Other
************************************************************* * * * *** * * * *ai * * * * * * * * * * * * * * * * * * ** -
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, . ' 1g cos ;on and zoning.
i
er or Agent
Date I ( ®`-'
Date ('1 i W
chc 6/18/03
From:
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
10050 NE 2 " AVENUE
MIAMI SHORES, FL 33138
RE: BPP -10 -08 -1887
KNOWLES RESIDENCE
129 109 STREET
TO WHOM IT MAY CONCERN,
PLEASE CANCEL THE ABOVE PERMIT. THE JOB WAS CANCELED AND NO WORK HAS OR WILL
COMMENCE.
THANK YOU,
•
KEITH L. STUART
NATIONWIDE POOLS
06/17/2009 10:16
NATIONWIDE POOLS
"w/ - &,4oce#-icot,fo iwu"
CUSTOM POOL CONSTRUCTION
1923 NW 40th Court • Pompano Beach. FL 33 054
Office: 954.227.7665 • 077.497.7655 • Fax: 954.575.1975
www. nat i onwidepoolan dspa . com
E -Mail: nationwldepools@bellsouth.net
#820 P.001/001
.0
MI JUN 1 7 2009 JV
BY:___ e ____