PAINTType Insp'n Mot is '\
Date ia
Permit No. PacC 1 \
Name 'fl7® •
Address 10c-t 0 g- ` S f
Company
Phone #
Inspection Date
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE 7
BUILDING DEPARTMENT
305- 795 -2204 cb
Building Inspection Request
Miami Shores Village
rEcEavE® uilding Department
1 50 N.E.2nd Avenue, Miami Shores, Florida 33138
OCT 22003 Tel: (305) 795.2204 Fax: (305) 756.8972
• � Permit No. 8P05-1 /�-
BUILDIl
PERMIT APPLICATION Master Permit No.
FBC 2001 f -
/`y atirsc de- 1
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) /�'� €5 /7/31 /ley Phone # 3 5 7-
Owner's Address /0 7 /KA • -- 7 S
City Am-in / 5 AaRe State /9 Zip 3 3)
Phone # 3
•
Tenant/Lessee Name 4/7/5/-
Job Address (where the work is being done) . e/ ,T1 e .95 n o1/e
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO
(Continued on opposite side)
Contractor's Company Name
Contractor's Address
City State
Qualifier
Total Fee Now Due $
Phone #
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
75' /72V
Zip
Architect/Engineer's Name (if applicable) Phone #
o
$ Value of Work For this Permit 5a 0 Square Footage Of Work:
Type of Work: ['Addition ❑Alteration ['New ❑ Repair/Replace ❑ Demolition
Describe Work: ALI/✓T a(/7 4 /
Submittal Fee $ ,' U ' C�v Permit Fee $ CCF $
Notary $ S .°L) Training/Education Fee $ Technology Fee $
Scanning $ Radon $ Bond $
Code Enforcement $ Structural Plan Review. $
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
who is perso
NOT
Sign:
Print:
The foregoing instrument was acknowledged before me this /1
day of X 20;x, by '! Vim` :e y
My Commission Expires:
APPLICATION APPROVED BY:
Chc 10/14/03
known to me or who has produced
As identification and who did take an oath.
PUB IC: p Id a Vargas
+m ' ssio
on o., nc.
Signature
sae ,0/ )-efier- s
Contractor
The foregoing instrument was acknowledged before me this
day of ,20_,by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: .
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * * * ** * * * * * * ** ****************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * *y+y ********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
2 /1 \3 \ b3
Plans Examiner
Engineer
Zoning
Date /e.--02?"--°3 Tfi
Owner's Name e5 ' 8n /Zex t/ Phone
Owner's Address / 4/: / 7
City M3/97( 5 State /s1• Zip
walls p �� e s �°/Q7 k459 7-1 Fascia `j
Drip Cap /drip Edge
Soffit j/1 "i ,
Roof
Flower bins
Shutters
Awnings
Chimney
Doors and door jams
Garage doors
Railings
Fences
Decorative metal
All brick (simulated or regula
Stucco banding
Any other stucco features
Accessory Buildings
Other
Signature
APPLICATION APPROVED BY:
Miami Shores Village
Paint Color Approval and Agreement
Owner or Agent
P& 2 A cial
33(35
Job Address (where the work is being done) /075- /K , 7
City "A S. Miami Shores Village County Miami -Dade Zip 3 31 3
Is Building Historically Designated YES NO
Contractor's Company Name (if applicable) OteWe/\ Phone # 3 7
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All elements on the site must be listed and indicate the color to be painted
'xTerna � r
ty licicieN
aaUUIVO vv I I% iii «..
iivm
Attach Color Samples
With Numbers
Desert Warmth 70YR 56/190
en, a..
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
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.
Date /G_2/'a
Date
chc 6/18/03
Contractor
Local Phone:
FEE2003 -6795
FEE2003 -6796
FEE2003 -6797
Building Fee
Notary Fee
CCF
Permit Number:
Applicant: JAMES BAILEY
Owner: MANZO LOUIS
JOB ADDRESS: 1098 NE 99 ST
Contractor's Address:
$60.00
$5.00
$0.60
I, _
Printed:11 /3/2003 Page 1 of 1
Parcel # 1132050180160 Legal Description: REV PL MIAMI SHORES SEC 8
Permit Status: APPROVED Permit Expiration: 4/26/2004 Construction Value: $300.00
Work: PAINT EXTERIOR HOUSE
PB 43 -69 LOT 7 BLK 179
Total Fees:
Total Receipts:
Signed: (Contractor or Builder) BY:
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.