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�
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* * ** 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.