340 NE 94 St (6)Date
Legal Description
Owner's Address
WORK DESCRIPTION
Square Ft.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address
Lessee / Tenant W\ Wl(g.M • \ kr � - Master Permit # -3/
4 ' 664
Contracting Co. )L`C ( Address
Qualifier SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one)'
LDING
noesr st Ne
Notary as to Owner and /or Condo President
My Commission Expires:
;Li 0 Nc . G'i Li 4- k ST
** * * * * * * * *
a
FEES: PERMIT 3u. RADON C.C.F.
APPROVED: Fire
Zoning Buildin
Mechanical Plumbing,
Tax Folio
Phone --/C('-(z r7
LECTRICAL PLUMBING MECHANICAL ROOFING PAVING
(NtyV _./}Aht
Estimated Cost(value) j °°(-)
c) ( -to4sc-
NOTARY
FENCE
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO 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).
Application is hereby made to obtain a permit to do work and installation as indicated above, and
on the attached addendum (if applicable). I 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, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
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 constructio ... zoning. Furthermore, I
authorize th a e• -named contractor to do the work stated.
Signature o o w n d /or Condo President Signature of Cont
Date: c Dat • " 4
X74 �'7Cyz�e �3 — -
or Owner- Builder
1 MAN eeaTIEl
* COMMISSION NUMBER
•' CC401261
4 • MY CO MISSION •EXP
(* / 1 6F f� * AUG, 17 19
Owner- Builder
SIGN
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TOTAL DUE
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Electrical
Engineering
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Building Permit
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 -795 -2204 Permit Number: BP2004 -1221
Printed: 9/9/2004
Applicant: DYNISE PERRY
Owner: PERRY DYNISE
JOB ADDRESS: 340 NE 94 ST
Contractor
Local Phone:
Parcel # 1132060136160
Page 1 of 1
Contractor's Address:
Legal Description: 1 53 41 6 53 42 MIAMI SHORES SEC 1 AMD PB 10 -70 W15FT OF LOT 6 & ALL LOTS
g8
Fees: Description Amount
FEE2004 -9172 Building Fee $100.00
FEE2004 -9173 CCF $0.60
FEE2004 -9174 Notary Fee $5.00
FEE2004 -9175 Training and Education Fee $0.20
FEE2004 -9176 Technology Fee $2.50
FEE2004 -9177 Scanning Fee $3.00
FEE2004 -9178 Builders Bond $300.00
Total Fees: $411.30
Total Fees: SW 3
Total Receipts: $0.00
34,0o
Permit Status: APPROVED Permit Expiration: 3/6/2005 Construction Value: $800.00
Work: ASPHALT RE- PAVING IN REAR DRIVEWAY
Signed: (INSPECTOR)
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:
BUILDING
PERMIT APPLICATION
FBC 4s VnJ■,L6
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) V' \\A'
Owner's Address 3 �-l�, `� 4-' t
City \,V.k A4 r1 t it-t -k State V
Tenant/Lessee Name
Architect/Engineer's Name (if applicable) 14 \ 4—
` T
$ Value of Work For this Permit
. 2rt
Submittal Fee !CD °I) Permit Fee $
Code Enforcement $ � —
Total Fee Now Due $
(Continued on opposite side)
r Miami Shores Village
3EP 7 ?,a pudding Department
1 50 N.E.2nd Avenue, Miami Shores, Florida 33138
J ® � U � Tel: (305) 795.2204 Fax: (305) 756.8972
vs- , Ft at - IL
/fib
Structural Plan Review. $
Permit No .k ^ ( c \
Master Permit No.
Phone #
Zip 1
Phone #
Job Address (where the work is being done) S 4 o ►.-k . C 4 -""A ,
City Miami Shores Village County Miami -Dade Zip . 5 '')1 r
Is Building Historically Designated YES NO____
Contractor's Company Name
Contractor's Address
City State Zip
Qualifier
State Certificate or Registration No. Certificate of Competency No.
Square Footage Of Work: '7 0 6 'S L-H
Type of Work: ❑Addition ❑Alteration New .Re air/Re lace
p p ❑Demolition
Describe Work: Q .Its
Vo•C 7 )L C T.L :U (2-1 v c '7-t.) Pe7 `_ ! /10J(.141/0712(
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
CCF $ Or 60 CO /CC
Notary $s _ a U Training/Education Fee $ 7 Of RO Technology Fee $ a j �
Scanning $ Radon $ �" Zoning Bond $ ""3
�l.✓
■
Phone #
Phone #
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
NOT
Sign:
Print:
r� ✓u
4 Angela M9
. My Commission DD150048
' xpires November 15, 20be
My Commission Expires:
Chc 05/13/03
APPLICATION APPROVED BY:
7/
a t t LA
Signature
Owner or A
The foreg_ing instrument w . owl ed before me this ( The foregoing instrument was acknowledged before me this
, s y i 1 Jo, A °� — , day of , 20 _, by
known who is personally to me or who has produced / who is personally known to me or who has produced
Ng and who did take an oath. as identification and who did take an oath.
My Commission Expires:
Contractor
NOTARY PUBLIC:
Sign:
Print:
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ma y' *** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
v
'STATE OF FLORIDA)
COUNTY OF DAD
The undersigned Affiant, 1� tn� l , does hereby attest that the
(property owner)
attached survey, performed by C- '`s (2-- (2, &Y\ t:/t -D r
(name of surveyor's company)
performed on1' is an accurate representation of the existing conditions and
p eP g
(date of s ey)
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)
Miami - ChoNe6 Uttar
Affiant/Property own
Witness(sign and print)
SWORN T SUBSCRIBED before me this day of . 2 O( "1
Affiant is personally known to me, produced as identification.
Dat
Type Insp
Permit No
Name
Address
Correction
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Re -Insp' n Fee ❑
Company
Phone #
Inspec ate / /(.1 J O y