1200 NE 91 Terr (11)1
BUILDING
PERMIT APPLICATIONju;
FBC 2001
Permit Type (circle):
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
_
n
Plumbing
Master Permit No.
Electrical
Owner's Address 1 Z 0 0 _ ' ' E / 1 „
Owner's Name (Fee Simple Titleholder)
Cit tan
Tenant/ essee Name
Contractor's Company Name
Contractor's Address
City
Qualifier
Total Fee Now Due $
(Continued on opposite side)
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES_ NO
State Certificate or Registration No.
Architect /Engineer's Name (if applicable)
$ Value of Work For this Permit/(
State -,
State
Type of Work: dition ❑Alteration
Describe Work: �1/Z t r- all Se
a ic)-745
Zip
Phone # 3 oS 7Se o n t 9
Phone #
Zip
Zip
Certificate of Competency No.
S — �sy6
Permit No.
Mechanical Roofing
Phone # r6-c ? 6 ' J"
Phone #
Square Footage Of Work:
❑ Repair /R ,place ❑ Demolition
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ W. OD CCF $ 1 2-0 CO /CC
Notary $ S•00 Training /Education Fee $ • 1.4 0 Technology Fee $
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
, :4 ;1 G `' PAOD
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: 1 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
COMM ENCEMENT."
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 ..proved and a reinspection fee will be charged.
Signature
NOTARY PUB
Sign:
Print:
chc 05/13/03
Owner or Agent Contractor
The foregoin .trument was acknowledged before me this v The foregoing instrument was acknowledged before me this
day of Tor\ g , 20 by [) pie I/ ' epio1 IC : day of , 20 , by
who is personally kn to me or who h pf
a. ed who is personally known to me or who has produced
s identification ap,qVid take an oath. as identification and who did take an oath.
s r' NOTARY PUBLIC:
Sign:
° 9 Print:
5 4r:
************************************** x** 14 4 ****************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
My Commission Expires:
Signature
My Commission Expires:
************************************* * * * * * * * * * * * * * * *-*- ** - **-* ************ # # # # # # # # # # # * * * * * * # # # # # # # # # # # # ##
APPLICATION APPROVED BY: Plans Examiner
(/- V // Engineer
,) e Zoning
Miami Shores Village
Paint Color Approval and Agreement
Date
Owner's . • e Oki — 67774C) • Phone # g r 7S or
Owner's Address / Cif 1 3� 3
City � /�, <AP/ % State Zi p
Job • ddress (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES NO
,
Contractor's Company Name (if applicable) Phone #
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All elements on the site ite be listed and indicate the color to be painted
Walls
. 0 #1/.(
Fascia
Drip Cap /drip Edge
Soffit (./(1
Roof
Flower bins
Shutters
Awnings
Chimney
Doors and door jams
Garage doors
Signature
APPLICATION APPROV BY:
s mo
Railings
Fences
Decorative metal _
All brick (simulated or regular) ,. �k
Stucco banding
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 regulatin co j , ction and zoning.
County Miami
S r1 0 �r
Owner or Agent
Zip
c:rcry /i
Date
Date
cnc 6 /18 /O7
Type Insp'n i' 1 U\(A.l ' % wt1 t
'tb
Permit No. 1P zoos' D
Name (01(114,d . CAT \Q
Address IZO0 W
Company OWtAW
Phone # 5 /758 - oal `(
Inspection Date ( ) V a t 105
Approved
Correction
Re- Insp'n Fee
3032.
MIAMI SHORES VILLAGE ��
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date Q - t. Z()lO5
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 6/8/2005
Applicant: YOLANDE
Owner:
JOB ADDRESS: 1200
Contractor
Local Phone:
Parcel # 1132050010490
NE 91
Signed: (INSPECTOR)
Signed: (Contractor or Builder)
Building Permit
Permit Number: BP2005 -846
CITRO
TERR
Contractor's Address:
Legal Description: 5 53 42 WATERSEDGE
Permit Status: APPROVED Permit Expiration: 12/3/2005 Construction Value: $2,000.00
Work: PAINT
BY:
Page 1 of 1
1 (r l
:JJd v ui1h LJ
PB 9 -141 LOT 25 LESS W15FT & W35FT OF LOT 26
Fees:
FEE2005 -7340
FEE2005 -7341
FEE2005 -7342
FEE2005 -7343
FEE2005 -7344
Description
Building Fee
CCF
Notary Fee
Training and Education Fee
Technology Fee
Total Fees:
Amount
$60.00
$1.20
$5.00
$0.40
$1.50
$68.10
Total Fees: $68.10
Total Receipts: $68.10
9Et- 14 qL
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict
conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work
done by either myself, my agent, servants or employes.