BP-04-325Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2001
Miami Shores Village
Permit Type (circle): Building Electrical Plumbing Mechanical Roofmg
Owner's Name (Fee Simple Titleholder) / /b%1 L C J r;tSVLAS Phone # U ®Z `Z S' 1 - A14-9-
Owner's Address/i IV t 40 IA 1 1 C.-`00
`0 0 t
City 1/r4 ■ rem l 1A �S State ✓ PC, Zip / ZS 1
Tenant/Lessee Namel/
fp,
Phone #
Job Address (where the work is being done) V VO % i•lieN1 4 11 ' 711
City Miami Shores Village =P., Miami -Dade
Is Building Historically Designated YES
Contractor's Company Name
Contractor's Address
City i=3 State Zip '--
Qualifier /4
Architect/Engineer's Name (if applicable) /' / Phone #
if -3.5t ) - b'
$ Value of Work For this Permit
Total Fee Now Due $ ( 736
(Continued on opposite side)
Permit No. i3 — 3 ZS .
Master Permit No.
Square Footage Of Work:
Type of Work: Addition ❑Alteration ❑New ❑ Repair/Replace ❑ Demolition
Describe Work: V j VC N'V+'ij
****************************F
Submittal Fee $ Permit Fee $ CO 0 ° 03 CCF $ ` 0 0 CO /CC
Notary $ 6 -00 Training/Education Fee $ r P-0 Technology Fee $ ) . S 0
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Bonding Company's Name (if applicable)
Bonding Compare
City
Address
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 reinspectior/fee will be charged.
My Commission Expires:
Signature
Owner or Agent /` Contractor
The foregoing instrument was acknowledged before ore me this l O The foregoing instrument was acknowledged before me this
day of 11YQr , 20C�-1, by F)(t fi.Q�} VSO SQ- , day of , 20 , by
who is pers s y known to me or who has produced O' ' who is personally known to me or who has produced
1 01 0 8 CA-1 As identification and who did take an oath as identification and who did take an oath.
NOTAR : LIC Mabel V a S NOTARY PUBLIC:
ion #DD2319
Sign: 2007 Sign:
Print: J o o @ Bo
Ming Inc Print:
nded Thru
Atlantic Bon
My Commission Expires:
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * :********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc 12/15/03
tA{t 112004
Plans Examiner
Engineer
Zoning
• Paint Color Approval and Agreement
Date's /� 0
Owner's Name
t�/� �
0122e b�'k t® Loot Phone # C 7S 1 - 4
Owner's Address i/C) I rte f 14 /RID I GO \flt
-Cj-0/t$$ state / -
City �/1� 1 grr1 j / � Zip �/
Job Address (where the work is being done)
/IV) ( C) j i 4 L4 r%4 I rig CS) a rt.
City Mlami Shores Village County Miami Dade Zip o
Is Building Historically Designated YES NO
Contractor's Company Name (if applicable)
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
nn All elements on the site must be listed and indicate the color to be a
p inted
Walls 1'c6larL Go %Af - 1 r4LEI,
Fascia /An
Drip Cap /drip Edge
Soffit
l
Roof t f
Flower bins T
Shutters
Awnings
Chimney
Doors and door jams
Garage doors /J T E
Railings
Fences / 1. 1 44
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 zon
Signature
APPLICATION APPROVED BY:
Miami Shores Village
Phone #
rD Ni
CT
CT m
Fr 1
c
0
a
Date
Owner or Agent
Date ?
P& Z Official chc 6/18/03