PAINTI! (:C SIT ;AR 11
r
BUILDING
PERMIT APPLICATION
FBC 2001
Owner's Name (Fee Simple Titleholder) kDiCt
Owner's Address t D
City f l i CU t q idJk S State �" L
Tenant/Lessee Name 'jCt r�
PQi'c OCiSh
Miami Shores Village
Building Department
Permit Type (circle): /1uilding)Electrical Plumbing Mechanical Roofing
Job Address (where the work is being done) / / /) 6 ? 3 S7
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO
Contractor's Company Name Phone #
Contractor's Address
City State Zip_
Qualifier
Architect/Engineer's Name (if applicable) Phone #
Architect/Engineer's Address
City State Zip
$ Value of Work For this Permit ) ! orn Square Footage Of Work:
Number of: Bays Stories ( Families ( Bedrooms Baths
Type of Work: Addition I ['Alteration ['New El Repair/Replace ID Demolition
Describe Work: GtC.v11 - 1 - 1 ACC � c�v 0 , S p
(1
County Escrow Fee $ t 6 i) Permit Fee $ 4 U 7
Education/Training Fee $ Tech $ Scanning $
Code Enforcement $ Bond $ Struct. $
Minus Plans Check Fee $ Total Fee Now Due $
$4 .co
l� h Phone # CAS
Permit No. VP 203 — 1 ' 4
Master Permit No.
zip
Phone # : 3 > 5Z
Zip
Notary $
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Radon $
0
(Continued on opposite side)
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: 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 Ma of such posted notice, the
inspection will not be approved and ar-pinspecton fee will be charged.
1 �
Signature \ /_• _ P ( 4 Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this?. 1 The foregoing instrument was acknowledged before me this
day of\ c ) LA , 20 by by D \one. DG QV('rO►, , day of - , 20 , by
who person ally known to me or who has produced Of I VP r • who is personally known to me or who has produced
as identification and who did take an oath.
Si
Print:
93151% X%1 %5. a
NO
As identification and who did take an oath.
_/ ) 'll- 5104.
Y ry :�• • u •sk-
My Commission Expires:
APPLICATION APPROVED BY:
Chc7/7 /03
UBLIC:
NOTARY PUBLIC:
Sign:
Print:
• My Commission DD150048
4 Expires November 15, 2006
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * ** ******************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
My Commission Expires:
Plans Examiner
Engineer
JUL 2 4 2003 Zoning
DATE:
OWNER'S NAME:
ADDRESS: 1 1 (4-
ADDRESS OF SITE: 1 d n E 431 3
Walls:
Fascia: 1 /
Drip Cap /Drip Edge:
Soffit: t"1 l
Roof:
Flower Bins:
Shutters:
Decorative Metal: �- h
All brick (simulated or regular):
Stucco Banding: — ( C`.
Any other stucco features: `'— A ( �-
Accessory/Buildings: —
Other: Ih 1 G
Mia i i v horse Vffl
10050 Northeast Second Avenue
Miami Shores, Florida 33138 -2382
Telephone: (305) 795 -2207
Fax: (305) 756 -8972
www.miamishoresvillage.com
All Elements on the site must be listed and indicate the color to be painted.
Crhr'i tlico 4(1q&'
d-?) Cr. NI +two or'/
n
Awnings. 47/4
Chimney: `i' i)-3 �--Lr t t!-�rr1.
Doors an door ja s ' .'
•T_ 1 )- 3 C ()IQ ■►u, t F �
Garage Doors: 1,1- 3 Ci rvit frk St : q&.,
Railings:
Fences:
Date
Paint Color Approval and Agreement
hyv �t -�--�a ty ' /(unQ 1_1(1
cl a' PHONE:
I
nC c
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
11123 Cinnamon Sugar
11121 Honeycomb
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. I authorize the above -named contractor, if applicable, to do the
work stated. Furthermore, the paint colors will be as per the attached samples.
ati
Si nature of Owner Date Signature of Contractor Date
WHEN PAINTING IS FINISHED, CALL FOR FINAL
INSPECTION
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address 7/ 2 A16 23 5T- - Tax Folio 1
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant
f / a 30 7 S — 7 - 75
Owner's Address / � Z / vG �J /�� 5 Meer � Phone
Contracting Co. D G✓/z/G /e Address /� L
Qualifier SS# Phone
State # Municipal # Competency # Ins. Cc
Architect/Engineer Address
Bonding Company Address
Mortgagor Address - -
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION ale 9A-) 4- P4 iN % 7-Vs -e ( =A- o rz
Square FL Estimated Cost (value) oa / (77/0
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
i
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. Furthermore, I authorize the above -named contractor to do the work stated.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT ,+ RADON
C.C.F. ),(V) NOTARY
APPROVED:
Zoning Building
Mechanical Plumbing
otary as to C
My Commission Ex
Master Permit #
r/U
//
J �: • „ .. c .�
7
act
0
AM' SEAL
es: GLADYS J VILLAS
NOTARY 1 UBLUC STATE OF FLORIDA
COMMISSION NO. CC7Y4103
MY COMMISSION EXP.
1
002
?ft Signatur; , of Contractor or Owner - Builder D
130- D - 39-953 - -D /Jo• Os
Date
BOND
TOTAL DUE
UILDING
LECTRICAL
LUMBING
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
DATE
PERMIT N? 5342
Work to be performed under this Permit
)weer of
uilding
rchitect
Contractor's
License No
: ontractor j
r Builder
.egal Lot Bl. Subdi-
)escription vision
ddress of Value of Amt. of
uilding Project Permit
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the appli-
:tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
lans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
crmit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
;gulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon-
bility for work done by his agents, servants or employees.
Signed • By
INSPECTOR •
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
3rtaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
i accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
BY AUTHORITY
-- BUILDING
ELECTRICAL
PLUMBING
PERMIT N? 5342
Work to be performed under this Permit
Owner of
- Building ,414%11,4"
Architect
MIAMI SHORES VILLAGE, FLORIDA
Bl.
permit is granted is the understanding that the contractor or builder named above a
regulations pertaining to the work covered hereby whether shown on the plans o
sibility for work done by his agents servants or employees
Subdi-
vision
Value of
Project
DATE ®
U 1947
Contractor's
License No.
h4 ' i JJ
0
/
Contractor
or Builder
Legal
Description
Address of i�
Building /0 U //� This This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the appli-
cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
' ibility for a thorough knowledge of the ordinances and
ents or specifications and that he assumes respon-
Amt. of Uri/
Permit
Signed• F''6` By
INSPEcIOR
In consideration of the issuance to me of this permit I agree to perform the work cove,'ed hereunder in compliance with .aatl, ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifiOtions submitted to the proper authonit es of Miami Sbbres' Village.
In accepting this permit I assume res onsibility for a work c ne by either myself, my agent, servant or employee.
/ '
`ACT • • OB. I ILD
BY
AUTHORITY
Type Insp'n
33
MIAMI SHORES VILLAGE
BUILDING' DEPARTMENT
305- 795 -2204
Building Inspection Request
Date Time
nCi ROIn /--
Permit No. BP Q03 C I r l
Name QDO\r\CA.
Address ({ NF_ l 57
Company
Phone #
For I p . = ctor: q I Name & Date
Approved
Correction
Re- Insp'n Fee