PAINT PERMITRECEOVED
► JLJ 5 2003
BUILDING
PERMIT APPLICATION
FBC 2001
Miami Shores Village
Building Department
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
J
+ Owner's Name (Fee Simple Titleholder) Q t' t' e r y SA ` -i.e c Phone # C Jos') 7� 51- 2 S ' 0
Owner's Address Iv C . E , 101 / S4`v Pe+
City ON; A1.; 5 N eres State F1 Or A. Zip 33 'S8
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 40 N • e . 101 S4-r«.4-
City Miami Shores Village County Miami -Dade Zip 33 i 3 Q
Is Building Historically Designated YES NO
Contr 's Company Name Phone #
Contractor's A
City State Zip
Qualifier
Ar t/Bngineer's Name (if applicable) . Phone #
Architect/Engineer's A
City State Zip
$ Value of Work For this Permii 10 0 . OD Square Footage Of Work: 1 b O
Number of: Bays Stories Families Bedrooms
Type of Work: ['Addition ['Alteration ❑New ❑ Repair/Replace
.. ..\..Describe Work: Pp}; �✓ t )E4t , tsi✓ D C 14,0 j JC
* * * * * * * * * * * * * * * * * * * * * * * * * ** * Fees * * * * */ *") * * * * * * * * * * * * * * * * * * * * **
County Escrow Fee $ 0- Permit Fee $ � 'v Notary $ J POO
Education/Training Fee $ Tech $ Scanning $ Radon $
Code Enforcement $ Bond $ Struct. $
Minus Plans Check Fee $ 6s_ cco • Total Fee Now Due $ (Continued on opposite side)
to N,t tc-03 ()1a,.1-
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No. .P2a55 I 1 •
Master Permit No.
Baths
❑ Demolition
Bonding Company's Name (if applicable)
r •,
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 rein;pection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was ac owledged before me this 15
,20('J3,by .e 400 3Q1 , e✓ ,
y known to me or who has procuced 0 f i 1/lk
S41.37 'at -1-19S-0 As identification and who did take an oath.
c �S •O�
day of
who is personal
NOT
Chc7/7 /03
UBLIC:
Sig _
P it► ' I /'` ji _ • Angela M Becker
y ommission DD150048
My Commission Expires:
APPLICATION APPROVED BY:
01 11
f
Expires November 15, 2008
** * *, ter**********************l r************************************************ ** * * * **** * * * * * * * * * ** * ** * * * * ** **
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
Signature
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:
7//5/a3
Plans Examiner
Engineer
Zoning
. Miami Shores Village
Paint Color Approval and Agreement
Date � ` 03
s fl
Owner's Name Q. Pct u^
•
v L4ev ,t �+
Owner's Address JJ 1 'v • G • lot
City NI p1 r', S h of C .) . State 1 d n Cl a
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade Zip 3 7 1 3 8
Is Building Historically Designated YES NO 1-
Contractor's Company Name (if applicable)
All elements on the site must be listed and indicate the color to be painted s. W. calla" 1
w .
Walls S A r f A. Te A
Fasci L ;
Drip Cap /drip Edge 1
Soffit N f tr
Roof
Flower bins
Shutters
Railings
Fences
Decorative metal
Signature
0 pi-
N /F}
pr
Awnings
Chimney
Doors and door jams lC-
Garage doors
/// •ot :4 c
All brick (simulated or regular) N /rr
Stucco banding N 74'
Any other stucco features /✓ /
Accessory Buildings N%
Other liff
*** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
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.
APPLICATION APPROVED BY:
Owner or Agent
714
Phone # C 1 0 S +51 ` S 4-0
JA
Zip j 7 l 3 v
as 3 /irk 1ciS7.
Phone # e '�
Sassafras Tea
White on White
o ' 14_ t , itd
Date
Date
30GY 88/014
O /03
7//-
Chc6 /1803
90YY 77/201
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 3/06 Job Address N' E i b I FL, S+• Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant — Se ffr`' , A. . 5 L `r cr Master Permit # 39316
Owner's Address 3 N• E. f o 1 s t, Phone @°S) 3 i'111K
Contracting Co. 0\4114E P Address
Qualifier SS# lone
State # Municipal # Competency # _ Ins. Co.
Architect/Engineer Address 2/A
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIP'T'ION
Square Ft. 1 S 0 O Estimated Cost (value)
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.
Sign e of owner and/or Condo President G ate
Notary as to Owner and/or Condo President Date
My Commission Expires:
2c ' 1_P 0 ■I — 0 F Ho z5.6 P ti C2 J✓� �.C�f> 7
' Sign ure f Contractor or Owner - Builder
Notary as to Contractor or Owner- Builder
My Commission Expires:-__ _ ____ _ .-
.P(2Y P4 OF FICIAL nUfAa3V 0u0.1
7 <- E./lama C7 C9®:zi E 1I.L
TA V ' Q CC3(L I
OF FL AI) i. `i' `ej:'.'r
1seo
FEES: PERMIT l� RADON C.C.F. . S NOTARY TOTAL DUE
3 —I
Date
Date
S�
V5.
APPROVED:
Zoning Building /'J r r� ' Electrical
Mechanical Plumbing Engineering