BP-03-1896BUILDING
PERMIT APPLICATION
FBC 2001
Owner's Address
$ Value of Work For this Permit
DEC 4 2 %50
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
ilding Department
.E.2nd Avenue, Miami Shores, Florida 33138
el: (305) 795.2204 Fax: (305) 756.8972
103 Nt � 3rd . S±
Code Enforcement $ Structural Plan Review. $
Permit No. 1Sp2CXr3 8'
Master Permit No.
Permit Type (circl ,) : Building Electrical Plumbing Mec nical Roofing
Owner's Name (Fee Simple i re o er t C( l-�J'' Phone # 9 S - 6/
20 / Iry
City obi– (�J , state zip 3 3 b
Tenant/Les �- Name Phone #
Job Address (where the work is being done) —y–�
City Miami Shores Village County Mi ��d Zip
33f _�u
Is Building Historically Designated YES NO
Contractor's Company Name 0 Vim Ph
Contractor's Address \'
City State Zip
Qualifier
Architect/Engineer's Name (if applicable) Phone #
Square Footage Of Work:
Type of Work: ['Addition ['Alteration New ['Repair/Replace ❑ Demolition
Describe Work: 1 e((Enb r
Submittal Fee $ COS • GO. Permit Fee $ O .00 CCF $ $ (o 0
Notary $ CJ ho Training/Education Fee $ Technology Fee $
Scanning $ Radon $ Bond $
DEC 1 1 PAID
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 FCTRICAL 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 a, rov,_� ' d a re'nspection fee will be charged.
Own r or Ag nt
The foregoing instrument was acknowledged be
day of Dee, , 20 by i
who is personally known to me or w o has produced
NOTARY
Sign:
Print:
My Commission Expires:
* * * * * ** * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc 10/14103
As identification and who did take an oath.
fit 0
The foregoing instrument was acknowledged before me this
t yof ,20____,by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
bet Val" is
4 Sign:
Expires: Jul 13, 2007
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Print
Atlantic Bonding Co., Inc. My Commission Expires:
DEC 10 2003
Contractor
**************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examin
Engineer
Zoning
Date lc
Owner's Name
Owner's Address
City
Miami Shores Village
Paint Color Approval and Agreement
y
a
20 Ala) 13 %err
State
Job Address (where the work is being done) / 0,3 M / b 3 r_
City Miami Shores Village County Miami -Dade Zip 3 3 / SZ
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
Walls S 1 1
Fascia
Of
Drip Cap /drip Edge \. )
Soffit Udijit
Roof l IA-
Flower bins N
Shutters 0•► j IA
Awnings ►V I l*
Signature
Chimney iv
Doors and door jams
Garage doors
Railings
Fences
Decorative metal N l P
All brick (simulated or egular) Pck Ors P4iCxQ h
Stucco banding N � ✓�-
Any other stucco features N 14.
Accessory Buildings ( % -
Other t 2 S
*************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work l 15e dine in-compliance with all
applicable laws regulating construction and zoning.
Phone # ( 9 I gi) - Ye!) 6
Zip 3-3
Falling Star
Pale Orange
XlifO
rie_A
* * * * * * * * * * * * * * * * *
APPLICATION APPROVED BY: Date
P& Z Official
37YY 78/312
17YY 65/420
chc 6/18/03
Wispy Peach 25YY 70/365
Honeytone 31YY 81/214
4
Walls
Fascia
Signature
APPLICATION APPROVED BY:
Miami Shores Village
Paint Color Approval and Agreement
Date
Owner's Name tr Owner's Address L i R /J/ )5`r
Cit ms s; L® g State
t7.--
Job Address (where the work is being done) (Ai I r3 r(4' L±
City Miami Shores Village County Miami -Dade Zip 3 3/ V
Is Building Historically Designated YES NO l/"
Contractor's Company Name (if applicable) Phone #
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All elements on the site must be listed and indicate the color to be painted
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 constru . on and zonin
Phone #
Zip 7 3 - 3 D 6 4 7 C-1"
Date
Date /
chc 6/18/03