BP-04-1280..
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle):
Owner's Name (Fee Simple Titleholder)
Owner I 's Address t _- Z p g ,V )
City N Jpi4; ,502"0 State
Tenant/Lessee Name
Job Address (where the work is being done) 2g ` 4)a) 9(
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO__
Contractor's Company Name Phone #
Contractor's Address
City State Zip
Qualifier
State Certificate or Registration No. Certificate of
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Pe
Type of Work:
Describe Work:
11'
Total Fee Now Due $ �!J 1 • °
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
(c'>
❑Addition ❑Alteration ❑New ❑ Repair/Replace ❑ Demolition
?a) rt ex+t o c tau a ) co,CIA 60,662_ QnoL ,
** * *gy * * *t **** ** * **** * * ** * ** F ees * * * **** * ** * ** *** * * * * ** ** * * * * **
00 '-- � 46 t,
Submittal Fee $ .� • - Permit Fee $ (00 . ®® CCF $ ®(p 0 1 CO /CC
Notary $ 3 - 00 1
Training/Education Fee $ Technology Fee $ 50
Scanning $ Radon $ Zoning Bond $
Code Enforcement $
Electrical Plumbing Mechanical Roofing
c i3V eatr l k Phone # 71 3"16- 691c
9/ 57
Structural Plan Review. $
Permit No. EP
Master Permit No.
Zip 33i50
Phone #
REC r
SEP 2 3 'OU4
Square Footage Of Work:
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 FT FCTRICAL 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 Y JTR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR ( 14TTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT."
NOTARY
Sign:
Print:
Notice to Applicant: As a condition to the issuance of a building perniit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and cohlruclion lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded tice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit ix sued. In the absence of such posted notice, the
inspection will not be approved and a rei spection fee will be charged.
Signature Signature
er or Agent ��//��
The foregoing instrument w,as acknowledged before me this gc5
day of
who is personal
My Commission Expires:
APPLICATION APPROVED BY:
Chc 05/13/03
430
.f
f
c,
Contractor
The foregoing instrument was acknowledged before me this
9jlay of , 20 , by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Plans Examiner
Engineer
Zoning
. - Paint Color Approval and Agreement
#
Date 9 23k c
Owner's Name 305e 1q gOried e_
r Phone # ( .3°5)7VC — 5a 015
1
Owner's Address III
City P Meru 5 o tes State Zip 3 31 5
5-/
Job Address (where the work is being done) zei L)') 91
City Miami Shores Village
Is Building Historically Designated YES NO /.
Contractor's Company Name (if applicable)
************************************************************************************************************
All elements on the site must be listed and indicate the color to be painted
Doors and door jams
Garage doors
Railings
Fences
Signature
Walls , 4 XF L
Fascia C 13 V
Drip Cap/drip Edge C D
Soffit A) 0
Roof A) 0
Flower bins Ar 0
Shutters
Awnings
Chimney
Miami Shores Village
County Miami-Dade
,1.
Owner or Agent
APPLICATION APPROVED BY:
P& Z Omia1
a
Zip
Decorative metal
All brick (simulated or regular)
Stucco banding
Any other stucco features 1)
Accessory Buildings
6a c_b
Other &Ids
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.
3V5
Phone #
C ilZ/ 2 b °
Date
Date 74 3
chc 6/18/03