BP-04-913A
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle
Owner's Name (Fee Simple Titleholder)
Owner's Address 0 gag g Z Ct ,
City '►M S
Tenant/Lessee Name
Job Address (where the work is being done) S Ci vvi 2,
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name 5e) Phone #
Contractor's Address (f " '1
City State �v Zip
Qualifier
State Certificate or Registration No. Certificate e
Architect/Engineer's Name (if applicable) Phone
$ Value of Work For this Permit 3oo.o
Type of Work: ['Addition ['Alteration [New Repair/Replace ❑ Demolition
Describe Work: Pez i.1+1'19 G)e fevi Dv
Submittal Fee $ Permit Fee $ IOC)
CCF $ , (P0 • CO /CC
Notary $ ° Training/Education Fee $ , 70 Technology Fee $ l -5
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $
(Continued on opposite side)
Building
State PL.
****************************Fees******************************
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.220 6.8972
ECM
Permit No. 9 aoD 4 " q!a
aster Permit No.
Electrical Plumbing Mechanical Roofmg
t C i e . l _ , . K ► rick/ Phone # 3 ®S - 7Si "7 `f(o 7
Zip 3 31 3 8'
Phone #
No.
Square Footage Of Work:
Bonding Company's Name (if applicable)
r
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) G ¶ t 1 3 A
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 wi 1'# ' `timated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and con tihn lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the rd' +'notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the build ,g it is issued In the absence of such posted notice, the
inspection will not be approved -, d as reinspection fee will be charp 1
Signature - \ Signature
Owner or Age t Contractor
The foregoing instrument was ackn swledged before The foregoing instrument was acknowledged before me this
day of 20 , by at its_ i:r■ A /6 • day of , 20 , by
who is personally known to me or who has produced who is personally known to me or who has produced
NOTARY PUBLIC:
Sign:
Print: J\& Q \J01
APPLICATION APPROVED BY:
Chc 05/13/03
As identification and who did take an oath.
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
$ -, Mahe' Vargas
' ;- `. Commission #DD231984
Cxpiivs: Jul 13, 2007
My Commission Expires: ' 9b►1'■a" " � Bonded Thru
Atlantic Bonding Co., Inc.
My Commission Expires:
**************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** :• *************
.9675e Plans Examiner
Engineer
Zoning
•
Owner's Name
Owner's Address
City 111 S
Job Address (where the work is being done) 5ct w e
City Miami Shores Village County Miami Dade
Is Building Historically Designated YES NO X
Contractor's Company Name (if applicable) /
***************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All elements on the site must be listed and indicate the color to be Da' a t vs!
.:. ^ �LscPrNy 2B -
Walls -
Fascia 1, h to
Drip Cap /drip Edge 1,J
Soffit C—
Roof ? X �S�i rt 3
Flower bins e 1 Sh\n q
Shutters YN-G"-
Awnings 1U5 r-12.-
Chimney tr-Q--
Doors and door jams W k
Garage doors �F &'h L5 (w )
Railings ri-
Fences
Decorative metal
Signature
Miami Shores Village
1
Paint Color Approval and A �'�"�
P ai pp � eemen
All brick (simulated or regular)
Stucco banding tuate..
Any other stucco features
Accessory Buildings
Other
* * * * * * * * * * * * * * * * * * * * * * * * * * * * ** **
OWNER'S AFFIDAVIT: I certify
applicable laws regulating constru
APPLICATION APPROVED BY:
erciS f
o' information is accurate and that all work will be done in compliance with all
P& Z Official
Date /2/
Date
* * * * * * * * * * * **
she 6/18103
Miami Shores Village
Paint Color Approval and Agreem
Date 7 4 0 LI
Owner's Name / d�Gees l
1 4- ( e a l U - S ne # 30Sr-F?J " / -m] �6
Owner's Address /o s-bS'' A f 2C `-
S . State
ci ty
Job Address (where the work is being done)
Q' -ems
City Miami Shores Village
Is Building Historically Designated YES NO
Contractor's Company Name (if applicable) Phone #
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All elements on the site must be listed and indicate the color to be painted
Walls
Fascia
Drip Cap /drip Edge -
Soffit
L
Roof Q-1 - ` l
Flower bins -t(;S1
Shutters
Awnings
Chimney
Doors and door jams
Garage doors
Railings
Fences
Decorative metal DL-6
All brick (simulated or regular) h
Stucco banding 0
i
Signature /2� ((UL/-;
Owner or Agent
APPLICATION APPROVED BY: af v-'
Officjatt
Zip 3.3/3 F
E MMEET)
County Miami -Dade Zip
Any other stucco features
Accessory Buildings
Other
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
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.
Date )7 / V V
Date