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BP-04-1516BUILDING PERMIT APPLICATION FBC 2001 Contractor's Company Name Contractor's Address . City Qualifier State Certificate or Registration No. $ Value of Work For this Permit rn � V Total Fee Now Due $ (Continued on opposite side) Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 7 6.8972 A State ECEI ED IOV 1 8 ?,094 Permit Type (circle): Building Electrical Plumbing Mechanical Owner's Name (Fee Simple Titleholder) b. /v I SE C6� R6 Phone # 365 7 Owner's Address 8 N E l b G 5 r-REE T I City g 8 6ao RES State rtvoR 6 0 4 Zip 3 3 13 Tenant/Lessee Name Phone # Job Address (where the work is being done) ! 8 ME. lb SE City Miami Shores Village County Miami-Dade Zip 3 3 1 3 8 Is Building Historically Designated YES NO P/ Permit No. P ©V - / aster Permit No. Phone # Zip �� F Certificate of Comp Architect/Engineer's Name (if applicable) Phone # a � Square Footage Of Work: / el /� Type of Work: ['Addition ['Alteration , � . ❑New El Repair/Replace [I Demolition Describe Work: P4( ROOF �� L'� P 'f 6,S u, C (Ait ■J Is C.0 M, c-& * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ ‘?2-0 CCF $ CO /CC Notary $ Training/Education Fee $ (V Zip Technology Fee $ f. la Scanning $ Radon $ --^ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ 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. 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 fence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature e Owner or Agent The fore oing instrument was acknowledged before me this` The foregoing instrument was acknowledged before me this day of ' �` �� 'Y A(2 OMs day of , 20 , b has produced - who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBL Sign: P My Commission Expires: ************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * l t -- *************** * **** *** *** * **** *** *** * *** * * * ** APPLICATION APPROVED BY: Chc 05/13/03 llh I fer y NOTARY PUBLIC: G n t t7 Contractor lllll Gir 1 G (mell connisanp #DD323870 I' May 26.2008 R °.: ssion Expires: c Wing Co ' 1 Adanh * * * * * * * * * * * * * * * * * * * * * * * * * * ** ** W * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning Walls Fascia Drip Cap /drip Edge Soffit Roof W t Flower bins Shutters Awnings Chimney Doors and door jams Garage doors Railings Fences Decorative metal All brick (simulated or regular) Signature Miami Shores Village • Paint Color Approval and Agreement Date EAR 5E Wkl R6 305 Phone# 7 1 `' v Owner' Name ! " S11-12, � Owner's Address l V City_WW—S-141SZELitate Zip 3.3 1 3 e Job Address (where the work is being done) l ' l V (o S liZE'. City 1Vliami Shores Village County Miami -Dade Zip 3 3 ( 3 8 - / Is Building Historically Designated YES NO k/ Contractor's Company Name (if applicable) ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All elements on the site must be listed and indicate the color to be paint 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 law regulating construction and zoning. /(,/tAge- APPLICATION APPROVED BY: Owner or Agent Phone # Date G. su Date /JJ/ ?/07 chc 6/18/03