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BP-04-873Miami Shores Village RIovIb: Building Department 10050 N.E.2nd Avenue, Nfiami Shores, Florida 33138 JUN 2 4 2oe4 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDI PERMIT APPLICATION FBC 2001 Permit Type (circle): Building City l 1 �►—�l�l '�� Tenant/Lessee Name Electrical Plumbing Permit No.? c '73 Master Permit No. Owner's Name (Fee Simple Titleholder) Owner's Address i. b State PL Zip 331 3is Phone # Mechanical Roofing J o b A ddress (where the work is being done) 2 p C O � City Miami Shores Village County Miami -Dade Zip 33 6 Is Building Historically Designated YES NO Contractor's Company Name C(j1Nlto / a f-t7 'l Pit J Phone L� .�� /3i Contractor's Address / x{ /41e, l3() r .-- City l 0 leti ® State oCe - Zip A 3 /4' Qualifier • `'t,� Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit z7 15 Type of Work: ❑Addition ['Alteration :New * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ Notary $<, 6 V Training/Education Fee $ 6 Scanning $ Radon $ Total Fee Now Due $ ( � b (Continued on opposite side) Square Footage Of Work: Describe Work: * * * * * ** _ _ * * . ** * ** . * * * * * * * * * * * * ** CCF $ I , a a CO /CC Technology Fee $ IS Zoning Bond $ Code Enforcement $ Structural Plan Review. $ ❑ Repair/Replace ❑ Demolition Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Signature Print: /1/ G • ,. w 7 t • 2, My Commission Expires: APPLICATION APPROVED BY: Chc 12/15/03 w f tt A-Lin ci sti tq Too - (D5 - Vo/c y a3identifi My Commission Expires: 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.F,CTRICAL 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 the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Owner or Agent The foregoing instrument was acknowledged before me this 2 The oregoing instrument was ac ..I owl dged b day of 4vtt� , 2005(, by ,./O rcj e�K.cickr , day o 0 1 , by who is personally �� q�,. e ho Si cz rod iced who s personally known to me or who has prod ]� i}C AWrLWii ifs s . 10.2006 o did take an oath. NOTARY P NOTAR re me this2 1 1 ed 01) take a oath. L niE, *3r+ ©D d ap pir' &P��t�tiu+ 1 ". (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. **********************************>****************************************** * * * * * * * * * * * * * * * * * ** * * * * * * * * * * ** Plans Examiner Engineer Zoning MIAMI SHORES VILLAG 4,, Paint Color Approval and Agreement DATE: ta OWNER'S NAME: - 4 L Z` i r 14( PHONE: ,DV °7 5°(-? 02-5 ADDRESS: ' (Q k C� Z.- 1 £r ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** y DDRESS OF SITE: Z-t-t 6 1.2) q71 CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted. Walls teRi g4waad - a / Fascia /1 C - Q,..y' Drip Cap/Drip Edge N //p' Soffit JL / �t Roof wP9 Flower Bins ,t /,1 Shutters #► / 19' Awnings P" 6' Chimney �ziOtw — . fr7 Y �.� Doors and door jams /1G — 93 1)' Garage Doors /L /?- Railings 9,3 Fences w /4 a� � Decorative Metal NL —.6.3 �\ All brick (simulated or regular) Stucco Banding /v/ Any other stucco features , .,r,I a( G1.4,0 Accessory Buildings - 2 /ZF38 Other I2, A C de w 4 Building Official Date r Briarwood 73 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 w e k stated. Furthermore , the paint colors will be as per the attached 7 alf ,4---6z/ori Signature of Owner D to Signature o Contract ate *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED: WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01