1269 NE 94 St (4)BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) TA cynea. -Si* As, A S Phone # a� 73, - 0
Owner's Address M% 95e S l
City 1/ 01M/ State
. $ Value of Work For this Permit
Miami Shores Village
Building Department
2 2 fi
Zip
33/ 31
Job Address (where the work is being done) /167 ,t' 95* Sf
City Miami Shores Village County Miami-Dade Zip 33/3'
Is Building Historically Designated YES NO
Contractor's Company Name %goe 6 A `"R (
hone # " ) O r /3 l i
Contractor's Address / ' 76 it/0 /j/ 6
City / . , ii f State M Zip .53 /6',
Qualifier k •
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No. 13 (2ZCU' 1:34
'
Master Permit No.
Tenant/Lessee Name Phone #
Architect/Engineer's Name (if applicable) - Phone #
Architect/Engineer's Address
City " State Zip
Square Footage Of Work:
Number of: Bays Stories Families Bedrooms Baths
Type of Work: ['Addition ['Alteration ❑New ❑ Repair/Replace ❑ Demolition
Describe Work:
cX44e e-47‘
1 v
* * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** CO
Escrow Fee $ J y () Permit Fee $ 6 , Notary $
Education/Training Fee $ Tech $ Scanning $ Radon $
Code Enforcement $ Bond $ Struct. $
Minus Plans Check Fee $ Total Fee Now Due $ (Continued on opposite side)
o CL 3 {C5 .1600
Bonding Company's Name (if applicable)
Bonding Company's Address
City
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State
As ide
APPLICATION APPROVED BY:
Chc71/ /03
State
Zip
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is suWe ,la att, , en . _ Also a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspecti. .,.. f i , A. :3" after the building permit is issued. In the absence of such posted notice, the
inspection will not NV J f ' ,� = ` ;.,` will be charged
•
The foregoing instrument was acknowledged before me this l Y
�( .J , 200) , by
day of l(l�,t, �j lA.�
who is personally o�►le or who has produced
, :t,:•- : „ • , ,� ;t , l, Q .t� o dath.
■
C �' o Expires Apn1 10, 2006
�� '' 0.00$ Bonded Thru
Sign: _ g co., Inc.
-
Print: / 1 L a ta J 4-, i ,' vfc ,
My Commission Expires:
o Y P � Mitoi ivq,,:,,
ae
The foregoing instrument was ackno lerdgeedd( jjb��eforre me this iS
20(22, by ll ' Jo ` 1 ,
who is personally known to me or who has produced L —
.. as id egpi lhit t1& ,an oath.
o ilk mmission # DD231984
x AZ 13' 07 it . � r
My Commission Expires:
day of Ac.f (A"\-- ,
NOTARY P
Sign:
Print:
AUG 1 8 2003
Al is Mgt ertificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No. (7 /4013/
............. *••»**................................. ss�, ry7 s**** s* s * * * *s * *s *s *•s *s * * *s * *s......s **
Plans Examiner
Engineer
Zoning
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE: /V*
OWNER'S AME: r, -y,,,} . PHONE:3ot- 7S / -U3Z/
ADDRESS: 126 ? he 9 •
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: /26? wt 9• •
,ONTRACTOR & LICE if applicable) � « At
COMPANY NAME: 7./. PHO :(3oT -
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
* * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls
Fascia LiK Gv
Drip Cap/Drip Edge 44
Soffit !.r •tug. W'
Roof i
Flower Bins w / �'
Shutters
Awnings IN y
Chimney .' /0
Doors and door jams l
Garage Doors L+ 4014. Lvh-
Railings '' / r1
Fences ,+ /11
Decorative Metal N `//
All brick (simulated or regular)
Stucco Banding ti /
Any other stucco features
Accessory f' `6?"--
Other
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 work stated. Furthermore , the paint colors will be as per the attached
sam es.
r 3 I
to Signature of ContractoV Date
Signatur f Owner D gn
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED:
Building Official
a i /)
Date
egi %a-
s/401 -itafte
1 /A
n
Likt.a4c 404
u •
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
Cocoa Beach 983
4/23/01
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 8/19/2003
Applicant: THOMAS
Owner: SIMS
JOB ADDRESS: 1269 NE 94
Parcel # 1132050100080
Signed: (INSPECTOR)
Building Permit
Permit Number: BP2003 -1347
SIMS
THOMAS
ST
Contractor COMPLETE HOME PAINTING Contractor's Address: 1476 NE 130 STREET
Local Phone: 305 - 895 -1368
Permit Status: APPROVED Permit Expiration: 2/11/2004 Construction Value: $2,285.00
Work: PAINT EXTERIOR OF HOUSE AS AGREED
Page 1 of 1
Legal Description: MIAMI SHORES BAY VIEW PB 40 -16 LOT 9 LOT SIZE 75.000 X 125 OR
Fees: Description Amount
FEE2003 -5072 Building Permit Application Fee $60.00
FEE2003 -5073 Notary Fee $5.00
FEE2003 -5074 CCF $1.80
Total Fees: $66.80
Total Fees: $ 6.80 Pi ,44. Total Receipts: - .86 O(
�
v,,,,,_ b 8
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 responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
sJ