BP-04-180BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circl Building Electrical • Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder)
Owner's ddress
City '.. State ?" Zip. - 3 11
Tenant/Lessee Name
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade Zip 931 - b
Is Building Historically Designated YES
Contractor's Company Name
Contractor's Address
Architect/Engineer's Name (if applicable)
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
City Stagg ;: j.
Qualifier
$ Value of Work For this Permit 1 SO •00
NO
Total Fee Now Due $ lV ' 1 9 )V (\ 1. FEB 1 1 PAID
=gym
Permit No. '5F 4 150.
Master Permit No.
Phone #
Phone #
Zip
.Square Footage Of Work:
Type of Work: ['Addition ❑Alteration [New ❑ Repair/R lace ❑ Demolition
Describe Work: /0 ,44, Vtit 414 C�
r�,��
C _ * *, *** * * * ***** * *a* *+toga *** * ** F ees * * *** *� *** * ** * * ** *wit * ** * *** * **
Submittal Fee $ ( 9 • ,.1) Permit Fee $ , 00. CCF $ s (, 0 CO /CC
Notary $ 5 -CO Training/Education Fee $ ' P—C.) Technology Fee $ 1 - SC)
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Bonding Company's Name (if applicable)
P ,
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 PCTRICAL 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
Signatur
Chc 12/15/03
My Commission Expires:
State Certificate or Registration No.
APPLICATION APPROVED BY:
Signature
Owner or Ag Contractor
The foregoing instrument was ackno • edged before me this 1 I The foregoing instrument was acknowledged before me this
day of F e , 20 Qs, by T Sl i yi r day of , 20 , by
who is personally known to me or who has produced; ll • who is personally known to me or who has produced
1 ` _ As identification and who did take an oath. as identification and who did take an oath si me _ # I # I 46 ‘_„...;— i i iik ''- tilmi,s,i.71101032,321247 NOTARY PUBLIC:
NOTAR / � %LIC:
( 1 % ' : tlantic Bonding Co., Inc.
Print:
(Certificate of Competency Holder)
My Commission Expires:
Certificate of Competency No.
********************************** * * * * * * * * * * * * * * * * * *** * * * * * * * * * *, ******* * * * * * ** * * * * * * * * * * * * * ** * * * * * * * **
P1anR Examiner
Engineer
Zoning
FEB 1 200k
MIAMI SHORES VILLAGE it
Paint Color Approval and Agreement ty--vrNsz,
DATE: i, V"' / r te'44 PHONE 0a -FS 4 ffG 3
R'S NAME:
OWNER'S
. ADDRESS: 9 r y ,'c k� ; , - .. z
****** *,*******************,**************,**************A4 ,
ADDRESS ADDRESS OF SITE: ? l d V `'/ ' e—
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
tents on the site must be listed and indicate the color to be painted.
Walls ) / ate 6
Fascia u )I(1k Ve -
Drip Cap/Drip Edge
Soffit toil'1 \ V -
Roof L) 0 -
Flower Bins 13 0
Butters 0
Awnings 130 _
Chimney OCR" < i ' "
Doors and door jams P 0
Garage Doors -<
Railings <.; `71
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
do the work stated. Furthermore the paint colors will be as per the attached
s . r pies, .
Signatur of • ` e f •
* * * * * * * * * * ** * ** *** D *� * * * * ** � Signature.
��� of **** �� ** * * * * * * * * * * * * * **
APPROVED: WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
Building Official Date
0
4/23/01
Walls
Fascia
Drip Cap /drip Ed
f
(
Ai '
0
0
Soffit
Roof
Flower bins
Shutters
Awnings
Chimney
Signature
i
APPLICATION APPROVED BY:
Miami Shores Village
/aint Color Approval and Agree n e1
Date
Owner's N. a �/��� Phone #
(per's ddress ` Y' /gyp f� G i#& -&..
City 1 f4,46E State Zip 3 3 /
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
0
applicable laws regulating construction and z
9g /44 oak/iivt-L-` 44-&-e
County Miami -Dade Zip
NO
Contractor's Company Name (if applicable) Phone #
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
1 elemenr n the site must be.listed and indicate the color to be painted
Owner or Agent
Doors and door jams
Garage doors
Railings
Fences
Decorative metal
All brick (simulated or regal
Stucco bandin
Any other stucco features
Accessory Buildings
Other
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
OWNER'S AFFIDAVIT: I certify that all the oregoing information is accurate and that all work will be done in compliance with all
P& Z Official
Date
2 004
chc 6/18/03