BP03-1306A
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): (Building Electrical Plumbing Mechanical Roofing
y �
Owner's Name (Fee Simple Titleholder) a =`sd. 1 �.,.., ��, a a. - ` " Phone # �u� ` � 1 ' �
Owner's Address f. A
City idl. v t l . °6,,, t'e
Miami Shores Village
Building Department
State Zip
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 7 /. °7
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO
Contractor's Company Name ALI—
Contractor's Address ,;..- = :
City 11 C State j t.
Qualifier PA x4 `i -t`
Number of: Bays Stories
Type of Work: ❑Addition [Alteration
Describe Work: .i ,� t'' ��. ' + ,:a
Families
[New
Master Permit No.
Phone #
Permit No. ( G D U
Zip
Zip ") )t
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Architect/Engineer's Name (if applicable) _ Phone #
Architect/Engineer's Address
City State Zip
! _
$ Value of Work For this Permit Square Footage Of Work:
Bedrooms
fe** * * * *,a * * * *** *,* * ** * * * ***** F *,* ** * * *** * * * *** ** * * * * * * *** **
Baths
Repair/Replace [ Demolition
r r '
•—'
County Escrow Fee $ r; • '1/4'13 Permit Fee $ Notary $
Education/Training Fee $ Tech $ Scanning $ Radon $
Code Enforcement $ Bond $ Struct. $
Minus Plans Check Fee $ Total Fee Now Due $ (Continued on opposite side)
Bonding Cmmrianv'c Nam/. (if arnnticn' +lPl
Bo
C it
Mo
Mo
Cit;
AP1
con
con
WE
or
app
PA'
CO
CO
Not -- - -- --- _ - - -•- -- -•-- ..._-- . - -- -.• » •••••• »•••6 Y" ,. ' ..• ' ••,• ....c coacn.uwaa rutuc ca,ccutng .P JVV, the uppttcunt 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 commencem nt must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issu,ed: \ In the bsence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
•
The foregoing instrument was acknowledged before me this / 4/ "The foregoing instrument was acknowledged before me this
day of .--' 204 ,by , day of .'
who is p - rsonall known to me or who has produced who iipersonally known tome or who has produced
as identification and who did take an oath.
NOTARY NOTARY PJBLIC:
Sigrr. i -- -=-- Sign:
Print: i W� r��%. l�N Print:
My Commission Expires:
************************************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency N
*********************** * * * * * ** * ** **** * *** * * * ** * * * * *._ *********************** *** ** * * * ** * * * * ** * * * ******* * * * **
APPLICATION APPROVED BY:
chc7/7 /03
0
0
0) 0
a�
o � Q
Q
a H k
to 0
' Cle
o t -I— &) "I §
, d
Q 'a z
c
H a, z
Owner or Agent
VJ
a G
< 0 a
As identification and who did take an oath.
Signature
My Commission Exp
SEP - 9 2003
Contractor
, 20;. , by
FREDERICK SHIRLEY
u R 44
• IMy CcimT -son Expres.iun 2Q 2006
Commission it DD037481
Plans Examiner
Engineer
Zoning
NOTICE OF COMMENCEMENT '
A RECORDED COPY MUST BE POSTED ON THE JOB SiTE AT TIME OF FIRST INSPECTION
PERMrr NO. TAX FOLIO NO.
STATE OF FLORIDA:
COUNTY OF MIAMI -DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real
property, and In accordance with Chapter 713, Florida Statutes, the following information
is provided in this Notice of Commencement
is name and 6 J `
5. Surety: (Payment bond required by owner from contractor, if any) , sprP �� cad
STATE OF �t (VIE1A. cn
Name and address:
Amount of bond $
6. Lender's name and address:
7. Persons within the state of Florida designated by Owrp u•on who
provided by Section 713,13(1)(a)7.. Florida Statutes;
Name and address:
different d to Os specified)
Signature of Owner
Print Owner's Name
� e ,z 2 /IP &O M
Sworn to and subscribed before me this .24_ day of
Notary Public
Print Notary's Name
My commission expires:
129.0142 PAGE 4 V32
:41 1 ; : Notary Public - State of Florida
My Commission Flies Mar 25, 2006
Commission 0 OD 102692
',,Gr of ' Bonded By National Notary Assn.
n I ; ay o7
Original /flea ) i; fs ounce on
f!+/ITAIC:'
• •4'nd Ufrfc$WI SUUP.
1 111111 11111 11111 11111 11111 11111 11111 1111 1111
CFN 200380687
OR Ek 21653 P9 2644; Ups)
RECORDED 09/16/2003 15:10:17
HARVEY RUVIH CLERK OF COURT
MIAMI —DADE COUNTYo FLORIDA
LAST PAGE
1. Legal description of property and street/address:
S r'- C T 1 E •--S ( e iA-,L-f4( 0
2. Description of improvement:
3. Owner(s) name and - address:
`Gq S Do '� ,� art ` av7 d � �, c S /et- � .
S 3 '
Interest in property:
Name and address of fee simple titleholder
4. Contracto d ddress• 4-c-
Prepared by
20 9.3
ntam! .t- served as
8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided
in Section 713.13(1)(b), Florida Statutes.
Name and address:
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
Address: 7 . 2 G L
Vii !�'►vt i ! a„�s �GJ
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oved
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'STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affiant, � ?` does hereby attest that the
(propl owner) / If
attached survey, performed by 610/Z-- 5 r 2 PA -5 d
(name of surveyor's company)
3-02.
(date of survey)
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the
performed on
property without first providing a survey less than six (6) months old. The Affiant, as property owner, further
agrees to remove or obtain permits for any structures which now may exist on the property which are not
permitted or which may violate zoning or building code regulations. The Affiant further understands that the
existence of any such structures may affect final inspections as applicable to this or other permits..
Further, Affiant sayeth naught.
Witness(sign and print)
/F6 bc r r/j -iJ . /M-6'
SWORN TO AND SUBSCRIBED before me this day
Affiant is personally known tome, '4oduced r • identification.
� as
RUTH A. RODRIGUEZ '0
r % Notary Public - State o Flora!$
i 4 4 Ccrnm n Ezra ! •r25, am
Commisalon c D0 102092
f 9n9ctl 11y National Notary Assn.t
, is an accurate representation of the existing conditions and
TYPICAL* HANDICAP
PARKING SPACE
5' .---- \
CAR STOP
o r Cvrb;
OFF- STREET PARKING STANDARDS
STALL DIMENSIONS
30'
.. TYPICAL PARKING
SPACE
f
4" SOLID COLOR DOUBLE STRIPE
CONTRASTING
WITH PAVEMENT
STRIPING DETAIL
ti
PERMIT NO. •
ADDRESS: .
MIAMI SHORES VILLAGE
BUILDING / ZONING DEPARTMENT•
SECTION
BY
DATE
ZONING
ELECTRICAL
MECHANICAL
PLUMBING
FIRE
" PUBLIC WORKS
STRUCTURAL
BUILDING OFFICIAL
1. Subject to campllancv vdth e11 Federal, State.
Cocmty. Vdtage rrdes and regulations. Village assumes
no responslbIllty for accuracy oflor results trout
these plans.
2. This copy of plans mutt be available on
building site or no Inspection MB be conducted.
JOB ADDRESS
APPLICANT
PHONE t#
APPUCATION
SHEET ._ OF
MISCELLANEOUS
DATE
___ 3 5 /t
-7_
ZO.NI,NG
( Ol l�ta
CRITIQUE SHEET
mot/' (C(
COMMENTS
INITIALS
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