210 NE 102 St (12)j. �
State
Permit No.
aster Permit No.
Mechanical Roofing
ne #
5
Zip N. 3,g)
Phone #
i -Dade Zip
Phone #
Phone #
i
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical
Owner's Name (Fee Simple Titleholder)
Owner's Address
City
Tenant/Lessee Name
• RECEIVED
�� 1 2003
Job Address (where the work is being done) �
City Miami Shores Villa
Is Building Historically Designate
Contractor's Addres
City
Qualifier
is Company Name
I VW
applicable)
Architect/Engineer's Nam
Architect/Engineer's Address
City
$ Value of Work For this Permit .
Number of: Bays Stories Families Bedrooms Baths
Type of Work: ['Addition Alterat •n ❑New ❑ Repair/Replace ❑ Demolition
Describe Work: (1 ,(mil 1 �lJ T
/0
Miami Shores Village
Building Department
Plumbing
v G go.00 pi) -�
• 0 /
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
a - \\49-
Zip
Square Footage Of Work:
* * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
I - 5.00
County Escrow Fee $ /� ! Permit Fee $ 0 Notary $
Education/Training Fee $ Tech $ Scanning $ Radon $
Code Enforcement $ Bond $ Struct. $
Minus Plans Check Fee $ Total Fee Now Due $ (Continued on opposite side)
c\c_ \Coo
/ riding Company's Name (if applicable)
3onding 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 INT , 9 TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE REC 1 .1 ING YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant: As a condition to the issuandit building permit w'ith 'an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and conslructiori law brochure will be delivered to fhe person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at 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.
Signatu
Owner or Agent
The foregoing instrument was acknowledged before me this \ \ The foregoing instrument was acknowledged before me this
day of C.1 ,20(3,by ElCA , day of ,20
who rsonally known to me or who h s produced who is personally known to me or who has produced
As identification and who did take an oath.
5so 67 05-0
NO
Si
Print:
LIC:/
/i1.J *! -
�1S�e A W: _41. •
as
My Commission Expires:
NOTARY PUBLIC:
An. - . „ _ - Sign:
Commission DD150048 Print
s November 15, 200r
*********************************** * * * * * *1r * * * * * * * * * * * * * * * * * * * ****
(Certificate of Competency Ho der)
Signature
Contractor
as identification and who did take an oath.
s:
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
State Certificate or Registration No. Certificate of Competency No.
* ****** *** ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc7/7 /03
7/a-0 3
JUL 3 0 2003
Plans Examiner
Engineer
Zoning
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE:
OWNER'S NAME: / / /.'. :u., /' " PHONE:
ADDRESS: Q
*******************************•** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE:
CONTRACTOR & LICENSE (if applic
COMPANY NAME: PHONE:
*** * * * * * * * * * * * * * * * * * * * * * * * *• * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls
Fascia
do the wor
sample
APPROVED:
Drip Cap/Drip Edge\
S
ower Bins
Shutters
Awnings
Chimney
Doors and door jams
Garage Doors
Railings
Fences
Decorative Metal
All brick (simulated or regular)
Stucco Banding
Any other stucco features
Accessory Buildings
Other
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. I authorize the above -named contractor, if applicable, to
ed. Furthermore , the paint colors will be as per the attached
///03
Signature of Owner bate Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Building Official Date
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
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0
0
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ro
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txi
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w
4/23/01
E Iv: )1
EC
JUL 2 4 2003
DATE:
OWNER'S
N
. ADDRESS: ,2 / /r, 6 o a
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE:
CONTRACTOR & LICENSE (if ap : 1• able)
COMPANY NAME:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls
Fascia
Drip Cap/Drip Edge
Soffit
AMI SHORES VILLAGE
aint Color Approval and Agreement
wer Bins
Shutters
Awnings
Chimney
Doors and door jams
Garage Doors
Railings
Fences
Decorative Metal
All brick (simulated or regular)
Stucco Banding
Any other stucco features
Accessory Buildings
Other
7/ e3
Building Officrdl Date
PHONE: 5e -,O 7 3 '
PHONE:
Spalding Gray
SW 6074
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. I authorize the above -named contractor, if applicable, to
do the work stated. Furthermore , the paint colors will be as per the attached
sample
VA25
Signature of Owner Date • Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED: WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01