BP-05-564Miami Shores Village
Building Department
10050 N.E.2n n cant - hor6s, Florida 33138
Tel'c 2 04 Fax: (305) \756.8972
•-
BUILDING rF 1F. Y Permit No
Master Permit NQ.
PERMIT APPLICATION
Job Address (where the work is being done) ! cV
City Miami Shores Village
Is Building Historically Designated YES
Contractor's Company Name 50
Contractor's Address
City 4i 13e
Qualifier
$ Value of Work For this Permit
Submittal Fee $
Scanning $ Radon $
Total Fee Now Due $
(Continued on opposite side)
Permit Fee $
o5
FBC 2001
AO*:
Permit Type (circle): Building % Electrical , Plumbing Mechanical Roofing --- / Phone 6:30.).7&te441)-3
Owner's Name (Fee Simple Titleholder)
Owner's Address _ ���,
City ...A.c -i..�� State
Tenant/Lessee Name — _ '
State Certificate or Registration No. Certificate of
Architect/Engineer's Name (if applicable)
‘
Notary $ Training/Education Fee $ 0, at)
Code Enforcement $ Structural Plan Review. $
County Mi mi- ade Zip ,334/ -74:8
NO (ildde�
7•1
Phone #
7 . Q 2,zS
Square Footage Of Work:
Type of Work: ❑Addition ['Alteration ❑New ❑ Repair/Replace ❑ Demolition
Describe Work:
****************************F
*** * *, * * * * *, * *, Fees *, *, * * *, *** * *** * * ** * * *** **** **
CCF $ � 6 CO /CC
Technology Fee $ )/
Zoning Bond $ °--�
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 absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowle
day of
who is personal
0 , by
wn to me or who has produced
As identification and who did take an oath.
NOTARY
Sign:
Print:
My Comm ; ion Expires:
20� Y PG A 'e
Vii
missraka sir
APPLICATION APPROVED BY:
chc 05/13/03
Ger
'c pion )
as
2;1984
on
n g C o
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
*
Contractor
The foregoing instrument was acknowledged before me this
day of ,20by
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:
Plans Examiner
Engineer
Zoning
•
Miami Shores Village
aint Color Approval and Agreement
Date -1• a i
Owner's Name /
, la
Owner's Address . _�• _- =. _ 74 - ../3
City tate '/ Zips
Job Address (where the work is being done) �•�V �' ♦ / a
Miami Shores Village
City
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
*dr L/ ' ' 0'e-a r
AAA
APPLICATION APPROVED BY:
Walls
Fascia
Drip Cap /drip Edge
Soffit
Roof
Flower 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.
County Miami -Dade Zip 197T
P& Z Official
Phone # (,,d 4/ 1
Attach Color Samples
_ Numbers
N Parmesan
G) uesauued
Date y / /p /
chc 6118/03