622 NE 97 St (5)((/��/ PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date O r l c 7 Job Address ,‘22 / �/ /e 97 Tax Folio
Legal Description ®� Historically Designated: Yes No
Owner/Lessee / Tenant ^�d� • QMOiJ / /�/ 1- 4/l0 1 Master Permit # V '&7 & 7 7
Owner's Address Phone 0Qc ^ 75 375
Contracting Co. OVA /U ��I - Address
Qualifier SS#
State # Municipal # Competency #
Architect/Engineer Address
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTIO AJ 1200 GJGI TT-
Po;‘,1 fi
Square Ft. Estimated Cost (value)
$ '7 3 6:1=7 u
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
construction and zoning. Furthermore, I authorize the above -named contractor to do the work/stated.
Signature of owner and/or Condo President
Address
Date Signature'o
i ' ,
or or
Phone
Ins. Co.
udder
O D
Date
t// y / /a
as to Owner and/o Condo President Date Notary /V No
Notary tary as to Con tor or Owner - Builder
My Commission Expires: My Commission E • ire •
4F`` Q CC797277
7.... s 4.-- MY COMMISSION EXPIRES
` OF PV' Dec. 17,2002
FEES: PERMIT RADON C.C.F. NOTARY BOND
Date
L / 7/o
APPROVED:
Zoning Building Electrical
TOTAL DUE
Mechanical Plumbing Structural Engineer
Date 09/ Job Address � �P' • Tax Folio // 3 /7 4, 0/7 14,7 /
Legal Description 1y/,,'/ S#/OdeES S 14 /9141r) Pi 45'1 L 7 $ YV / /.1 dG7 84.k /AO
Lessee / Tenant ,94 /,4/A ,. A &/✓5y'/ zrz Master Permit iPiJSa
Owner's Address �� ,`�, 27) • 7
Contracting Co. /1,o4E, °T' H// L, 1g
Qualifier SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 1r"4;
Square Ft. Estimated Cost(value) fr# B'f
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 construction and zoning. Furthermore, I
authorize th above -named contractor to do the work stated.
.
1
e p
g i
L
`` i t& % JOSEPHINE CHURCH
n . • lit W044303
CC197545
Signa
Date:
tar as to Owner a
** *
Commission ExpireE
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
owner and /or Condo President
FEES: PERMITS 7•5 RADON C.C.F. I I °'D ,NOTARY r: TOTAL DUE 1 ✓ f 5
Fire
Zoning uildin
i, 711 d- J Phone 767- h
A d d r e s s / / *W. /r Zur) ' M41/
S ignature f Contractor or Owner- Builder
Date:///1/11
0 : tar: as to
y Commission
.; JOStPHII+IE III
.N
atplismOmms
• MOM
**
Other
Electrical
Mechanical Plumbing Engineering
Type Insp'n
Phone #
MIAMI SHQ C 7LLAGE
BUILDING DEP TMEN
305- 795 -2204
Bu'lding Inspection Request
Date Time
For Inspector: 2 7 5 , I Name & Date
Approved ❑
Correction ❑
Re- Insp'n Fee ❑
fit
..
Permit No. be 20l.)3 1
Name DC.o11 v
Address "' 04 t•rE.
Compan Caq " 1'
f 3 6 s ( .
Date
Type Insp'n
Permit No. riP az3 - 3
Name Pe,1
\
Address 02
Company CO qYar) i
Phone #
For Inspector:
Approved
Correction
MIAMI SH , g*eLLAGE,
BUILDING EPAIZTMENT
305-795-2204
Building g Inspection Request
1
Re-Insp'n Fee
Time
Name & Date
Miami Shores Village
ATi&l N tt) Department
,r / a Building Depart
BUILDING Permit No.
PERMIT APPLICATION Master Permit No. i -- )0024. 1 1
FBC 2001
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) f 6 F etaYt� Phone # 30s. 154. 43(o
Owner's Address 6 a a 97
City A{ M41 c44.14 State z., Zip ?j 2 I3 g
Tenant/Lessee Name
Job Address (where the work is being done) (a AA A}
City Miami Shores Village County Miami -Dade Zip 33 l 3$
Is Building Historically Designated YES NO
' i16 1. A PPOik //
Contractor's Company Name D 1P:t�i[3ti� y lbi Phone # S . 733 • IP 5 g
0
Contractor's Address g3 N0 040 A' , 4P 30
City ivitfrif t 3o, c ` State 'L Zip 3 3 1/4 1
Qualifier
Architect/Engineer's Name (if applicable) 4L(& (A.kkok4 t _ Phone # 305 . Z3 7. CoStO
Architect/Engineer's Address V3t4 K1 12.0 • ctiot
City NUM 1 Walat State F Zip ( �
$ Value of Work For this Permit $3148.40 eO Square Footage Of Work: &DO
Number of: Bays Stories Families Bedrooms Baths
Type of Work: DAddition [l1teration New ❑ Repair/Replace ❑ Demolition
Describe Work: 741APTI&Mr 6F TsiZ teig. heAtL
County Escrow Fee $
Education/Training Fee $
Code Enforcement $
Minus Plans Check Fee $
1
Phone
#
* * * * * * * * * * * * * * * * * *. * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Permit Fee $
Tech $
Scanning $ Radon $
Bond $ Struct. $
Total Fee Now Due $ 1 (- j 1) (Continued on opposite side)
0 ,
Notary $ 0 c)
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if ap licable A LIAM' a M rtis
g f.
Mortgage Lender's Address got A( ( 1
City `rict a e) LW. State `Fab
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.
0
Signature Signature �� c � C�
WWW v
Owner • p nt Contracto(
�
'7
The foregoing instrument was acknowledged before me this i / The f. regoin • , instrument was ac . owledged bef• re me this/ 7
day ,20a2_, by " 1), ➢ q)'\ 8 \Ay\ I da of\_ =j ,2 by
who is personall known me or who has produced —L 0 L who is personally i own to moor who ha produce • fl D) D 3-as iciettification and who did take an oath.
-- 1)50.-- c i crl 1 - As identification and who did take an oath. e /As3R
chc7/7 /03
NOT " P :r IC:
Sign:
Print:
My Commission Expires:
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
APPLICATION APPROVED BY:
Expires November 15, 2006
NOTARY P
Sign:
Print:
Zip 3,223
Ji: •'
' oo Expires November 15, 2006
My Commission Expires:
Plans Examiner
Engineer
Zoning
Shutters
Awnings
Chimney
Flower bins
Doors and door jams
Garage doors
Railings ' U44
Fences kale
Decorative metal
Signature
•.
Paint Color Approval and Agreement
Date `� r ®
Owner's Name a 18 Q4 E" • Phone # 305- 7454 - 43
Owner's Address A 4g gift. 3 °
City Qq ti 0
MiFITE
State — FE. ,
Job Address (where the work is being done)
City Miami Shores Village_
Is Building Historically Designated YES
Contractor's Company Name (if applicable)
* ******* ** ************ * ******* ** ** ** * ** ** *** ** ** ** **** ** * ** *** ** ** ** *** * *** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
All elements on the site must be listed and indicate the color to be painted
Walls L� Alleam&
Fascia "Laa *t ®al R-4
Drip Cap /drip dge - / V A
l
Soffit kikt-
Roof ij g +0 j' J
APPLICATION APPROVED BY:
Miami Shores Village
i,A7w
County Miami -Dade
NO ✓®
4- \OGo CM P-
0 1-1 11-
All brick (simulated or regular) ° 55 /ta'
Stucco banding 54,4 V AAA.% '
Any other stucco features 5 ctAl Mobhutytir
Accessory Buildings
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 cons tri ion and zoning.
P& �
P& Z Of ial
Zip
33
Zip
Phone #
S 73 40
Silvery Moonlight • 50BG 63/014
Date •G1 3
Date
747k 3
Chc6 /1803