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PT-05-1234BUILDING PERMIT APPLICATION FBC 2001 Code Enforcement $ Total Fee Now Due $ vZ . 80 (Continued on opposite side) Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 $ Value of Work For this Permit ' 2 - 0 CD ` CDC—) Structural Plan Review. $ Tenant/Lessee Name Phone # Permit No. P 12341 Master Permit No. Permit Type (circle): Building Electric .1 Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) -' ZZ— / v /L U. Z Phone # Owner's Address cP.S Ai C 9 5 . City HO Al / --) eel 9.1 State -e c_46 b2.30. zip " 33(35/ Job Address (where the work is being done) S i / �/ e . 9 � . City Miami Shores Village County Miami -Dade Zip 33 1 3 D Is Building Historically Designated YES NO Contractor's Company Name Q Phone # Contractor's Address City State Zip Qualifier State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Square Footage Of Work: Type of Work: ['Addition ['Alteration [New ❑ Repair/Replace ❑ Demolition Describe Work: ,®L} 10+ I ) Pr1 O tT ****************************F Submittal Fee $ Q Permit Fee $ . CD® . CCF $ t" ). (=DC7 CO /CC Notary $ Training/Education Fee $ C c Technology Fee $ 1 Scanning $ Radon $ Zoning Bond $ DEC 15 PAID Bonding Company's Name (if applicable) w 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 att hment. lso, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs s' (7) days after the building permit is issued In the absence of such posted notice, the inspection will no i , approv! d 1R pection fee will be charged / /1dit) i , ieror .;,� Signatur Signature Contractor The foregoing instrument was ac I edged before me this 13- The foregoing instrument was acknowledged before me this day of J._, 20 by � l/ZZ /// JJD �7kr ay of , 20 by who has produced who is personally known to me or who has produced tion and who did take an oath. as identification and who did take an oath. Si a - Je._ :deiC ROD f. a mfr `1�' r Nota�,ePlci!iia r. My Corm ,E My Co `r 31 ° Iirr ;ril I orida K 1' 008 , My Commission Expires: ' OF rtc,„ ` Lam{ ■. ,�j e ^ r� , eeaeuee e * * ** wti ** *92144 it ikl 8 * ** ** * ***** ** ** *> Fie********************* a** ** * * * ***** **** * * * * ** *** * *** Chc 05/13/03 ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: Plane Examiner Engineer i 5 Zoning NOTARY PUBLIC: Sign: Print: Date a Miami Shores Village Paint Color Approval and Agreement C3U5� ZS`6 -4 Zql Lpt Z.Z.. R ra t G v E Phone # Owner's Name 5 Ng • q C( •SLr r Owner's Address Z. (�.� 1 City VI t a. r)0 State l- t, � `-' Zip ? 3 i 3 Job Address (where the work is being done) oc S City Miami Shores Village County Miami -Dade Zip 33 1 3 <( Is Building Historically Designated YES NO Contractor's Company Name (if applicable) Phone # ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All elements on the site must be listed and indicate the color to be painted walls 17 S 9 M , \ A 0 t'L- 5 >• D Fascia VA 025 W Re.5 }-O 2.A + Y , Drip Cap /drip Edge C w O-6 Soffit 0 5 124_54'0 (2 Roof Flower bins Shutters Awnings Chimney /� ,r� -� Doors and door jams 7 g 55 5 e"'� LI\ sp.) C€ Garage doors '�, 1 2 S5 D 0.-. 0.-. i't ) �P ` �C-C_� ^ Railings ` s 1- N t,t 4- 15 €'D ,,, Fences ,, l Decorative metal /� � s�71 t- uaa J �t� � " v All brick (simulated or regular) ( . Stucco banding Any other stucco features Accessory Buildings Other ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** OWNER'S AFFIDAVIT: I certify :.. the foregoing information is accurate and that all work will be done in compliance with all applicable laws re Y el{ I .: l ctio and oning. IV i t '7 41110 Signature APPLICATION APPROVED BY: -- l 0 ct z Date Date / chc 6/18/03 Job Address: 25 99 Street NE Miami Shores Village, FL 33138- Work Classification: Miscellaneous Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Issue Date: 12/19/2005 Expires: 12/15/2006 Owner's Name: LAZZ MASSON RODRIGUEZ Permit Type: Paint Contractor(s) Phone Primary Contractor Comments: PAINT HOUSE Additional Information 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 responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. Fees Due CCF Education Surcharge Permit Fee Technology Fee Total: Amount $0.60 $0.20 $60.00 $1.50 $62.30 Building Depart 4f Applicant Si• eV le Copy Invoice Number PT - 12 - 05 - 23096 Total: Parcel #: Block: Section: Permit Status: APPROVED Permit Number: PT -12 -05 -1234 Phone: Total Square Feet: Total Valuation: Reauired Inspections Final Amt Due $62.30 1132060131270 Lot: PB: 0 $ 200.00 Amt Paid $62.30 $62.30 NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. Issue Date: 12/19/2005 Owner's Name: LAZZ MASSON RODRIGUEZ Permit Type: Paint Work Classification: Miscellaneous Job Address: 25 99 Street NE Comments: PAINT HOUSE Additional Information Finance Copy Miami Shores Village, FL 33138- Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Expires: 12/15/2006 Contractor(s) Phone Primary Contractor 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 responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. Fees Due Amount CCF $0.60 Education Surcharge $0.20 Permit Fee $60.00 Technology Fee $1.50 Total: $62.30 Permit Status: APPROVED Permit Number: PT -12-05 -1234 Phone: Parcel #: 1132060131270 Block: Lot Section: PB: Total Square Feet: 0 Total Valuation: $ 200.00 Required Inspections Final Invoice Number PT - 12 - 05 - 23096 Total: Amt Due $62.30 Amt Paid $62.30 $62.30 NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.