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BP-04-408, .rj BUIL G PERMIT APPLICATION FBC 2001 Electrical Plumbing Mechanical Roofing / X Owner's Name (Fee Simple Titleholder) e 4147 4. Phone # , 5 45 ,f7 3_3 Y7 Owner's Address 1/3 Iii I- D r City .� / ri r State � r/ Zip ,„3 ra O' 7 Tenant/Lessee Name Phone # Permit Type (circle): $ Value of Work For this Permit Qualifier ,4 ,it'G / - - J /po e Total Fee Now Due $ g- C i 0 (Continued on opposite side) Miami Shores Village Building Department Job Address (where the work is being done) City Miami Shores Village Is Building Historically Designated YES NO C� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit N © L E D 1� Master Permit No. � County Miami -Dade Zip Contractor's Company Name ame j7 /'� {' ( U fimmi/ Ph # C5 6- Contractor's Address / ,� ; /( •' ; �� ( �� /� City � /`/, / l l3 h State � � � j Zip 3/6 Z. Architect/Engineer's Name (if applicable) Type of Work: ❑ ddition ['Alteration ['New /�l / New / ❑ Repair/Replace ❑ Demolition Describe Work: � Oesc/A1 �&#X- 'FAX S" 4 /PM C ie.4 7 ***** Submittal Fee $ Permit Fee $ CO 0 • 0O CCF $ 1 0 KO CO /CC Notary $ S. 0 0 Training/Education Fee $ a Co 0 Technology Fee $ 0 Scanning $ Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ Square Footage Of Work: 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. W 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 $2500, the applicant must promise in good faith that a copy of the notice of commencemere and uction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the re noti gf commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permii is ei the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. ' Owner or Agent contractor The foregoing instrument was acknowledged before me this 19 , The foregoing instrument was acknowledged before , me this d a y ofVO,�: 200 , by -0I 7 ? ; i l n Lt.) a f 1 day ofeeg' aw , Nog , by Q1( l 9J6 o A ho is ersonally known to me or ,.* , t as produced 1) T Lwho is personally known to me or who has produced q As identification and who did take an oath �Q as identification and who did take an oath. My Commission Expires: APPLICATION APPROVED BY: Ghc 12/15/03 r � Signature Atlantic Bonding Co., Inc. (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. ****** * * *** ** * * * * * * * * * * * * * * * * * * **** MAR 2 4 2004 Plans Examiner Engineer Zoning L-- r **************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Miami Shores Village Paint Color Approval and Agreement Date 3,S'h Owner's Name Owner's Address 7/,3 /r z ye, S .)/ ° State Job Address (where the work is being done) /43 4' S` W / City Miami Shores Village County Miami-Dade Zip Is Building Historically Designated YES NO . Contractor's Company Name (if applicable) /0 H C C$ / . / iP Phone 1 ij ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All elements on the site must be listed and indicate the color to be painted Walls 6-1 /3C1 /i Fascia itt- < 1., C/ Drip Cap /drip Edge Soffit Roof 0 P4it -7' Flower bins Q E 5 g4kee ,VS Shutters fie /V Awnings /l ` i tt Chimney Sol MP 4s wogs Doors and door jams � ,, / Q Garage doors `L' h Railings 4 h /'t Fences Decorative metal All brick (simulated or regular) 4.11/ tg Stucco banding Any other stucco features Accessory Buildings Other ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Signature � r' /��,d214 APPLICATION APPROVED BY: Owner or Agent P& Z OfKial Zip •x /.1 Phone # 7 .? s 9' 7 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 3 � 9/ 1 chc 6/18103