870 NE 92 St (10)PROPERTY OWNER -
New Construction
Name fro s , � ��
/ E �
Alteration Exterior
Address
e7c eft e ' Vgd ST •
Repair
Home Telephone 3,05 - .151 - , 5 �y
Business Telephone 9,42.14_ 6cv
`t' ,:
Fax 4 i,6- 7 (r 60,2 -- ken--5
Shell Only
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'1 Attachment
Other
Add'I Detachment
Other
r/ Job Address:
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step 1.
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit-
ted along with this permit application.
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
A PPLICATION
Address
Folio Number
Lot Block
Subdivision PB PG Zoning Linear Feet
Current Use of Property Square Feet Units Floors
Proposed Use of Property Value of Work
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
77 . (. 9zad
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Master Permit No.
Subsidiary Permit No.
14a�g h i=
A t. City j � State ��
V \ Description of Work . a-I✓ �'" P �
Bldg Value
PERMIT APPLICATION
Zip
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
Address
Telephone Fax
Qualifier Name
Page 2
IMPORTANT NOTICES
1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
STA
Sign of Notary
SEAL:
Y OF MIAMI -DADE
tc.
d subscribed before me this ) 9
M •.'_
w: ¢ CC7e6t397
-9 ' MY CO!f ISSIOH FxDiS'S
`c OF f „15,2002 _11
Personally known OR, Produced Identification
Type of Identification
Identification Produced:
.0050 N E 2•.o AVENUE
F L O R I D A
33138
kvy Cl`� f try t.L„
. FOs
� Are � � 7R 15 4 i•
000 101118 : eve' c 04 _ Ifni,o v
h,':'` -' /7 O L00' 9
q; ��.P�% eta ' & 4= 0
C. q'i . •r 11'' a • oWitZ,,
`L::..;4'cYht.# — „� J%ativtries of A ejica
o� % f830 :,, calve Blvd. ).'0
•
�°�
43each, FI. #(60
s
iii lli iIf lliillili i li lilii lilii li lii I I' li iii li iii lii it
r
3NI1 0311001V 01Od'SS3800V N9013e 3H1J0
1H9I8 3H1013do13AN3 dC, dO11V Id3N 119 30Vld
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1, 2, and•3. Also complete
item 4 if Restricted Delivery is desired.
• Print your name and address on the reverse
so that we can return the card to you.
• Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
2. Article Number
(Transfer from service label)
A. Signature •
X
,; I; i
Y -
B. Received by (Printed Name)
D. Is delivery address different from item 1?
Jf.YES, ente el livery address below:'
3. Service Type
Certified Mail
R gistered
❑ Insured Mail
❑ Agent
❑ Addressee
C. Date of Delivery
❑ Yes
❑ No
61 (A1 {' 1 : +[,,,-Ek 1 4sfe r ►es
o . ArnPh c .c
13'3a5 B sc &' ne e 1)/1,
tL - o
Nor- -)\ . al I ,aY n ► each, Ft
3 - R(6 D 4. Restricted Delivery? (Extra Fee) ❑ Yes
❑ Express Mail
❑ Return Receipt for Merchandise
❑ C.O.D.
rlon/ ,_5 /1) c)4,6:1 osLi) (
PS Form 3811, August 2001 Domestic Return Receipt 102595 -02 -M -0835
November 15, 2002
Mr. Marvn M. Libowitz
Gulf Atlantic Industries of America
18305 Biscayne Blvd.
#210
North Miami Beach, Fl. 33160
RE: Portner
870 N. E. 92 St.
Dear Mr. Libowtiz:
It has come to our attention that your company recently did work on the driveway at the
above referenced home. This work was done improperly and without permit. Therefore,
we have assessed a double permit fee and a penalty.
The total cost for the permit is $226.20. It is your responsibility to pay and pick up this
permit and contact me about the work done on this driveway.
Your attention to this matter is appreciated.
Sincerely,
CBE /ab
Charles B. Esher
Building Official
cc: Tina Portner
BUILDING DEPARTMENT
10050 N.E. SECOND AVENUE
MIAMI SHORES, FLORIDA 33138-2382
TELEPHONE (305) 795-2204
FAX (305) 756 -8972
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
U.S. Postal Service
CERTIFIED MAIL RECEPT
(Domesti) Only; No Insurance Coverage Provided)
i fl n I 1
1 .] Zi [ —
Postmark
Here
Postage
Certified Fee
Return Receipt Fee
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
Total Postage & Fees
tecilkio.A lq lAt
re
or PO Box No. 183 QS — ±1 i i . sc , B11/ d .+4
Ci State, ZIP+
3 c - 0
Ai
FS Form 3800. January 2001
See Reverse for Instructions
- -t
Miami Shot
10050 NE 2nd Ave` u
Phone: 305 - 795 -2204
Printed: 8/23/2002
Applicant: TINA
Owner: PORTNER
JOB ADDRESS: 870 NE 92
Contractor
Local Phone:
Parcel # 1132060050140
Fees:
FEE2002 -4729
FEE2002 -4730
FEE2002 -4731
Description
Building Permit Application Fee
CCF
Notary Fee
Total Fees:
Amount o
$60.00 --J"'"(5' o o, O
Total Fees: $6&20
$1.20
$5.00 e .� Total Receipts: $0.00
2$0
ermit Status: Approved Permit Expiration: 2/19 /2003 Construction Value: $2,000.00
rk: DRIVEWAY REPAIR
If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
(\) fee is $50.00, which must be paid in advance before calling for anothAr i�14:110/` +t••..
TINA S. PORTNER
870 NE 92ND STREET
MIAMI SHORES, FL 33138
Pay to the order of
CITIBANK. F.S.B. 47
HOLLYWOO L3119 IVE
Memo
Village
V 47
2660
31o753793 e ..-
Date/ j
1:2660865541: 3 L0 7 5 3 79 360' L L8
Buliding Permit
fp
Legal Description:
Permit Number: BP2002 -1484 e
Contractor's Address:
oz
PORTNER
TINA
ST
118
GOLDEN GATE PARK ADDN PB'Qi Code T Ordinances, rt Including
tau ($r�ii Z T SIZE
Page 1 of 1
�i►Id�i,l SI#':;R%S VILLAGE
NOTIC
Owner is Responsible for M"intenance of
All Village Sidewalks as per Village of Miami
ipment or device described in the application herefor in strict compliance with all
y plans, drawings, statements or specifications that may have been submitted to
me in compliance with such ordinances or if the plans are changed without
wilder named above assumes the responsibility for a thorough knowledge of the
the statements or specifications and that he assumes responsibility for work done
ance with all ordinances and regulations pertaining thereto and in strict conformity
e. In accepting this permit I assume responisibility for all work done by either
11
;q- A
/.e
Cc �'
12, 8o
/44 12.45
2'
27,da
?111 1 a1.111%%11110111' 1111: NIGNATIIMI.'
AND 1111 1jk11.,AAI. NAt \1.11 S1:Al. 11Y
11.1111111A 111 t.NSI.Ir NII1111's OK
AN11111414'11
or
ll
3
2
tr
0•
A .5 00
PROPERTY OF: Portner,
= /Zr
,
Go
s
Co4c;
.
� e
,des; dam. - x6e m
3.77' • 22 /o' g g /2,4o•
i t) o /6.55 kii
•- 22./0•
>f
Gu ,r'e rile G -yn� b �J
7s, o0
1,
3'X3'
p/G
A BOUNDARY SURVEY
1 hereby certify that the survey repre-
sented hereon meets the minimum
technical siandards set forth by the Board
of land Surveyors in chapter 61G17-6
Ilorrda Administrative Code pursuant to
Section 472.027. Ila. Statutes. There are no
en( mat hmenls. overlaps, easements
appeatmot on the Plat. other than .as
shown hereto.
111. ►.or.avrlvlvorlANDa1 Nu.7
fif
2
0
•1
This property described as:
Lot 3 and the East 1/2 of
• Lot 4, Block 2
GOLDEN GATE PARK ADDITION,
according to the Plat
thereof, as recorded in
Plat Book 6, Page 130
Q of the Public Records of
Dade County, Florida.
9 1 �IrL
Tina, 870 N.E. 92nd Street, Miami Shores, Florida
LANNES AND GARCIA, INC.
L.B. 11 2098
SURVEYORS- MAPPERS -LAND PLANNERS
ERNESTO E. ESPINOSA #2946
Offke address: 359 Al Avenue. Corel (:.bles.'Florldll 33131
(303) 666-7909 (954) 523 -1663
FIELD•DATF
0
SCALE
/ a
/L �' E % y i /• GAr Jn) r
/e .00• _...
c 74.2 / 77a AD
X/o -/ 7 . GQ /e
I'agc 1 of 2
DRA N O Y DRWG. NO
402
.
c
• .0fr/
1
1/
OP /
4.'
2
O
Y
�2
3
zel
25
26
50'
#
,
•
5o'
11
;q- A
/.e
Cc �'
12, 8o
/44 12.45
2'
27,da
?111 1 a1.111%%11110111' 1111: NIGNATIIMI.'
AND 1111 1jk11.,AAI. NAt \1.11 S1:Al. 11Y
11.1111111A 111 t.NSI.Ir NII1111's OK
AN11111414'11
or
ll
3
2
tr
0•
A .5 00
PROPERTY OF: Portner,
= /Zr
,
Go
s
Co4c;
.
� e
,des; dam. - x6e m
3.77' • 22 /o' g g /2,4o•
i t) o /6.55 kii
•- 22./0•
>f
Gu ,r'e rile G -yn� b �J
7s, o0
1,
3'X3'
p/G
A BOUNDARY SURVEY
1 hereby certify that the survey repre-
sented hereon meets the minimum
technical siandards set forth by the Board
of land Surveyors in chapter 61G17-6
Ilorrda Administrative Code pursuant to
Section 472.027. Ila. Statutes. There are no
en( mat hmenls. overlaps, easements
appeatmot on the Plat. other than .as
shown hereto.
111. ►.or.avrlvlvorlANDa1 Nu.7
fif
2
0
•1
This property described as:
Lot 3 and the East 1/2 of
• Lot 4, Block 2
GOLDEN GATE PARK ADDITION,
according to the Plat
thereof, as recorded in
Plat Book 6, Page 130
Q of the Public Records of
Dade County, Florida.
9 1 �IrL
Tina, 870 N.E. 92nd Street, Miami Shores, Florida
LANNES AND GARCIA, INC.
L.B. 11 2098
SURVEYORS- MAPPERS -LAND PLANNERS
ERNESTO E. ESPINOSA #2946
Offke address: 359 Al Avenue. Corel (:.bles.'Florldll 33131
(303) 666-7909 (954) 523 -1663
FIELD•DATF
0
SCALE
/ a
/L �' E % y i /• GAr Jn) r
/e .00• _...
c 74.2 / 77a AD
X/o -/ 7 . GQ /e
I'agc 1 of 2
DRA N O Y DRWG. NO
402
1 o,
4/
N � N
NN
2
O
• .o0,/
'is
' Z 2
So'
23
24
,
25
26
So'
3 0
1"
S :'... O` /7' Pc? a//771H/
/./ E. 92 5__/ I■
o
eS
1401 t Al 11) 111111011r Inc Ste:NA'1'URE
Anti 1111 11R11.1NA1. R. \1%1.11 N:A1. ID
11.11111 NA 1 It'L NN.0 51%5110k
AND MAr1'R
PROPERTY OF Portner
5 . ,° ar,&-uai
75 o0
Tina
A BOUNDARY
3'X3'
/� l/
et s o ��r .f 767
/0•Z4
C)
Gu irC ��C G7 "E . Oe
mss, oo • . �, .
V)
/'r
ow
0
Nis
870 N.E. 92nd Street, Miami
SURVEY
1 hereby cerItly that the survey repre-
tenterl hereon meets the minimum
set hnit al standards set forth by the (bard
of land Surveyors in chapter 61G17-6
Ilorldi Administrative Code pursuant to
Section 472.027. IIa. Statutes. There are no
ern' roar hments. overlaps. easements
appearing on the Plat. other than at
shown heteto.
FIELD DATE SCALE
/0-Z7-9 /" '
i
GOC� 1/.0 0 /27a
X/01 749 Ga'e
This property described as:
Lot 3 and the East 1/2 of
• Lot 4, Block 2
GOLDEN GATE PARK ADDITION,
according to the Plat
thereof, as recorded in
Plat Book 6, Page 130
Q of the Public Records of
1 , Dade County, Florida.
401 ;/f
Shores, Florida
LANNES AND GARCIA, INC.
L. D. a 2098
SURVEYORS - MAPPERS -LAND PLANNERS
ERNESTO E. ESPINOSA #2946
Office address: 359 Alcanar Avenue, Cord (.ables,'Florlda 33131
(305) 666-7909 (954) 523 -1663
Page 1 111' 2
p %t
CN
DRA NJIY DRWG. NO
• 402
rI- 0RIDA E
Ili • 1unshinr .Vale
TINA :It!:;AN 8011TN1••17
II 8 S'I'I11iI:T 1110
M I A M I lIk4tl1, Et. .1"1119-0000
I : I 1 'A I 06•A
112 14 °1994
8815 817 54 957 0 y12 - 2000
•i1.ASS: E
SAFE DRIVER 00 -0 00
s0995022191
Tax Folio #:
requests permission to install:
Lot Block Subdivision
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on thi
SIGNED, SEALED AND DELIVERED in the presence of:
iumi Sh,oreo
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 -2382
Telephone: (305) 795 -2207
Fax: (3051756 -8972
COVENANTT F CONSTRUCTION WITHIN RIGHT OF WAY
WHEREAS, PA-(4 eC• C� /� , hereinafter referred to as the Owner of the
(owner)
following described property:
Legal description/folio #:
Asphalt, concrete, brick pavers
J Landscaping
[j Other
within the public road right of way of ?7o 7)4- . % C6
(address)
IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows:
1. To maintain and repair, when necessary, the above- mentioned item(s) installed within the dedicated right
of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said
items within public right of way including restoration of street by reason of the Owner's failure to do so,
such expense shall be paid by the Owner or shall constitute a lien against the above described property
until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or dade County harmless from
any and all liability, which may rise by virtue of permitting the installation of these items within the public
right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days
notice by the Village to do so. Failure to comply with this notice will result in the Village causing the
item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all
costs incurred in the removal and disposal of the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and
shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such
time as this obligation has been canceled by an affidavit filed in the Public records of Dade County, Florida
by the Village Manager of Miami Shores Village (or his fully authorized representative).
(owner)
J 1UCw!! y
f�PP�oi4C(-t
1. 4 to RID?
• AFFIDAVIT
STATE OF FLORIDA)
COUNTY OF DADE)
<
The undersigned Affiant,� ..: POP
; does hereby attest that the
(property owner)
attached survey, performed by
(name of surveyor's company)
•
�U . all -, is an accurate representation Of.tbe existing conditions and •
(date of survey)
performed on
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
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)
SWORN TO AND SUBSCRIBED before me this day of
Affiant is personally known to me, produced as identification.
Afnant/Properpy
Witness(sign and print)
Notary
ELECTRICAL
TYPE
Minimum Fee
QTY.
mg.:
Dryer
QTY.
Tv1I:
Outlet, Appliance
Q.1.V
TN IT
Service Repair
Q.Q.I
A/C Central 1 -3 Ton
Dryer Vents, Number of
Fan
Ventilation, Cost
Outlet, Wall
Ductwork, Cost of
Service, Temporary
Periodic Inspections
A/C Central 4 -7 Ton
Fire Sprinkler System
Fire Pump
Outlet, Switch
Fireplaces, Number of
Signs
A/C Central 8 -15 Ton
Fixture - Fluorescent
Oven
Space Heater (kw)
A/C Central 16-20 Ton
Fixture Light
Parking Lot Lights
Spas/Hot Tubs
A/C Central 20+ Ton
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Chiller
Generators, etc.
Receptacles
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low -volt, Burglar
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Water Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
MECHANICAL
TYPE QTY.
Minimum Fee
TYPE
Condensate Drain
QTY .1.x.1,1,.
Generator
()Ty. TvrE Q
Refrigeration, Tons
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Bath Fan- Vented, #
Fireplaces, Number of
Pressure Vessel
PLUNIBING
TYPI:
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
TYPE.
Miscellaneous Fixture
QTY.
'rvl'E
Soakage Pit
QTY.
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Pump, Sump
Utility - Water
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
Domestic Well
Laundry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply ,
Page 3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
RECEIVED AND REVIEWED BY: DATE:
SECTION
By
AT
y//1/13,
Zoning
J
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
t.`ya
ZAW
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
Cl OTHER
(Specify & Attach)
PERMIT FEES
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.) $
Inspector State Educational Fund $
State DCA (Radon)
Code Enforcement Fine
Zoning Review
Notary
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
I
O
(s .60) 1000
x
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ C:1)
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com