501 NE 92 St (13)r
BUILDING
PERMIT APPLICATION
FBC 2004
Miami Shores Village 12-11 c
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305 Iref))756,8972
100E L T�
Permit No.
BY: ___
- MaSter Permit No.
Permit Type (circle): Buildin ) Electrical Plumbing Mechanical Roofing / R �
Owner's Name (Fee Simple Titleholder) 3Vb G '9 - • Phone # ( A � - V-1:39 .
Owner's Address 15'6+ t- \ i�
Cityi ��Ct State - Zip 33\
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 43C\ N3.0 • — t2_ �'�
City Miami Shores Village County Miami -Dade Zip -1 5 2 D\
FOLIO /PARCEL# >> 3Z — Qk ,— oILA i1
Is Building Historically Designated YES NO K
Contractor's Company Name - v\V cporQA (owt Phone # ( — \y 3
Contractor's Address
City State Zip
Qualifier Name Phone #
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
V
Value of Work For this Permit $ 9c Square / Linear Footage Of Work:
Type of Work: ['Addition ['Alteration 11] Repair/Replace
II �, New ❑ Demolition
Describe Work: l �1 t - >4> C7 k - W A \\S rr A C {\) \
c —
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Feess******************************************Fees******************************************** Submittal Fee $ Permit Fee $ ( o O . 00 CCF $ CO /CC
Notary $ '5 — Training /Education Fee $ ` '0
Scanning $ Radon $ DPBR $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $
Technology Fee $ ( 30
Zoning $
Total Fee Now Due $
(01
See Reverse 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 the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Signature
Contractor
The foregoing instrument was ac ly wledged befAre me this L The foregoing instrument was acknowledged before me this
Owner or Agent
rr Q , day of ,20 ,by
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY P BL C: NOTARY PUBLIC:
day of C , 20 y
ca !)f ° Vargas
�tres• t.. '
3,c . + rh Print:
Co. frtr Sign:
Print:
My Com ission Expires: My Commission Expires:
* * * * * * ** * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * *, *************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY: Plans Examiner
Engineer
`�r s Zoning
(Revised 02/08/06)
Issue Date: 12/15/2006
Owner's Name: DAVID NELSON
Permit Type: Paint
Work Classification: New
Job Address: 501 92 Street NE
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Additional Information
Miami Shores Village, FL 33138
Expires: 06/13/2007
Contractor(s)
HOME OWNER
Phone Primary Contractor
Yes
Type of Work: Exterior
Additional Info:
Color:
Classification: Residential
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 responsibility for all work done by either myself, my agent, servants, or
employes. I understand that separate permits are required for ELECTRICAL,
PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING
POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work
stated.
Fees Due Amount
CCF $0.54
Education Surcharge $0.20
Notary Fee $5.00
Permit Fee $60.00
Technology Fee $1.50
Total: $67.24
Building Department File Copy
Applicant Signature
Invoice Number
PT - 12 - 06 - 27013
Total:
Parcel #:
Block:
Section:
Permit Status: APPROVED
Permit Number: PT -12 -06 -2998
Phone:
Amt Due
$67.24
1132060141120
Lot:
PB:
Total Square Feet: 0
Total Valuation: $ 900.00
Required Inspections
Final
Amt Paid
NOTICE: In addition to the requirements of this permit, there may be
additional restrictions applicable to this property that may be found in the
public records of this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.