BP-03-1993BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Bu' ¶ ng Electrical Plumbing Mechanical / ( Roofin)))
Owner's Name (Fee Simple Ti . N of • ; ) 4-frane Phone # (3O5) 75 / -
Q
/ 7 Owner's Address `y1/ / V� � /Q2 Site e.
City 2Xiei 2/ State FIJI .y�o : /� r
Zip 33 ��Q
Tenant/Lessee Name Phone #
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES NO ✓
Contractor's Company Name
Contractor's Address
City
Qualifier
Submittal Fee $ Oa • CO Permit Fee $ (f) . LTD
Notary $
Scanning $
Total Fee Now Due $ (.2Q7 .00
(Continued on opposite side)
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
1V11aI111 3110re5 V iii tge
Building Department
Training/Education Fee $ • 20
Tel: (305) 795.2204 Fax: (305) 756.8972
/79 Na /1/2 3 e7L
Radon $
County Miami -Dade Zip 33/51
Permit No. _ ' 2 - L ( 3
Master Permit No.
Phone #
Zip
Architect/Engineer's Name (if applicable) N// Phone #
$ Value of Work For this Permit +V W) Square Footage Of Work: / 0()
Type of Work: ❑Addition j ['Alteration ['New l
Describe Work: 1 /)17 PL ?li i " and 69116"67 4
mot C � Jh
CCF $ BOO
Technology Fee $ I.SO .
Bond $
RECEOVED
DEC 3 0 2003
tea uswellae=ficoafti'Maila.L.
❑ Demolition
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 FT.F,CTRICAL 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 b .approved and a reinspection fee will be. charged. •
Chc 10/14/03
Owner or Agent
The foregoing instrument was It before
day ofd , 2 by `:` p/f ',
APPLICATION APPROVED BY:
who is personally known to me or • o has produce
As identification and who did take an oath.
NOTARY PUBLIC:
S
Print
My Commission Expires:
N/i4
Contractor
The foregoing instrument was acknowledged before me this
yof ,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:
* ** ***** *sir * * * * ** ** sit * ** * * *** * * ** * ** *, * ************************************** * * * * * * * * ** * ** *a ** ** * * * ** * * * ** **
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
***** * * * * * * * * * * *** * * * * * * * * * * * * * * * * *J .- **** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
DEC 3 12003
Plans Examiner
Engineer
Zoning
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE:
OWNER'S N
ADDRESS:
* * * * * * * * * * * ** * * * **
ADDRESS OF SITE:
CONTRACTOR & LICENSE (if applicable) PHONE:
COMPANY NAME'
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements o ' e site must be listed and indicate the color to be painted.
�
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 to
and that all work will be done in compliance with all applicable laws re cable, to
construction and zoning. I authorize the above -named contractor,
do the work stated. Furthermore the paint colors will be as per the attached
(2.I3) q3
Building Official Date
- '114 Date
Sigma � ** Owner
Date • Signature of Contractor
WHEN PAINTING IS FINISHED,
APPROVED: CALL FOR FINAL INSPECTION
4/23/01