FW-06-633Miami h r Village m 3liq Io.
S o es e V g
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 OY t(J k
Tel: (305) 795.22'04 Fax :305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type (circle): Building Elec
Owner's Name (Fee Simple Title o . er)
Owner's Address
City
Tenant/Lessee Name Phone #
Permit No.
"rcuC, —g33
aster Permit No.
Plumbing Mechanical Roofing
/ ;n7,(> Phone # 3 tar 5 2
State Zip
Job Address (where the work is being done ) ®°2 77'
City Miami Shores Village County . Miami -Dade Zip -,7J /-f d
FOLIO / PARCEL
Is Building Historically Designated YES NO
Contractor's Company Name T Phone #
Contractor's Address
City State Zip
Qualifier Name Phone #
State Certificate or Registration No.
Architect/Engineer's Name (if applicable)
Value of Wo
Certificate of Competency No.
Phone #
inear'Footage Of Work:
Type of Work: ['Addition ❑Alteration
Describe Work: , 6
Demolition
* * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * ** * * * * * * * **
Submittal Fee $ Permit Fee $ CCF $ CO /CC
Notary $ Training/Education Fee $ Technology Fee
Scanning $ Radon $
Bond $ Code Enforcement $ Double Fee $
Structural Review. -$ Total Fee Now Due $
See Reverse side --*
DPBR $
Zoning $
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
Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this 13 The foregoing instrument was acknowledged before me this
day of NO Ch 20 06 byi carYJcS R G.04.1 n • day of , 20 , by
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
APPLICATION APPROVED BY:
(Revised 02/08/06)
Sign:
Print:
My Commission Expires:
Plans Examiner
Engineer
Zoning
1
r
LAND SURVEYING INC.
5951 N.W. 151• STREET. ' Suite 210
MIAMI LAKES, FL. 33014
PH: 305 807 -8640 8c 305 823 -3220
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N.E. 99th. STREET
20' ASPH. PVMT.
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NOT ID.
FENCES, WALLS, HEDGES
INSTALLED ON ALLEY MUST
ALLOW 40 SQ. FT. FOR
TRASH CANS, TREE TRIMMINGS, ETC.
REVISIONS:
DATE:
THIS SURVEY WAS PERFORMED DATE:
MARCH. 09, 2006
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JOB No CH -06014
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PROPERTY ADDRESS 802 N.E. 99 STREET, MIAMI SHORES, FL 33138
LEGAL DESCRIPTION: (FURNISHED BY CLIENT)
LOT 12 AND WEST 1/2 OF LOT 11 BLOCK 72 OF "MIAMI SHORES SECTION 3 "
ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 10 AT PAGE 37
OF THE PUBUC RECORDS OF MIAMI -DADE COUNTY, FLORIDA.
agYABILINEMAIRM
BASED ON THE FLOOD INSURANCE RATE MAP OF THE FEDERAL EMERGENT MANAGEMENT AGENCY DATED OR
REVISED ON 7/17/95 THE HEREIN DESCRIBED PROPERTY IS SITUATED WITHIN ZONE X
BASE FLOOD ELEVATION N/A COMMUNITY 120652 PANEL NUMBER 12025C0093 SUFFIX J
ELEVATIONS(WHEN SHOWN) REFER TO CITY OF MIAMI DATUM,
DEEM
1) JAMES P. GRIFFIN &W DEBBIE A.
LEGAL NOTES
THIS SURVEY DOES NOT REFLECT OR DEIERMUIE OWNERMIP.
ET(AHOAMON OV THE ABSTRACT Cf. TITLE Mt HAVE TO BE MACE TO DETER/MA RECORDED
INS08IMEN10. IF ANY. AFFECTING THE PROPERTY. THIS SURVEY IS SUR ECr TO EMS CATIONS.
UNITATKINS. RESTMCINNEL RESERATIONS OR FASEIFEWS OF RECORD. •ECM. DESCRIPTIONS
PROM= BY CL EM THE U EM* OF THIS SURVEY IS UMIIED TO THE COST OF THE SURVEY.
UNDERGROUND ENCROACHMENTS. IF. ANY: ARE NOT SHOIN. THIS MN 1180 NOT ATTENEM TO
LOCATE FODTAHG MD /C2 EOUND T S AND /OR UNDERGROUND MPRC1EMENTS OF
ANY NATURE. IF SHORN, BEmNGS Mc sumo TD AN MINED MEimDIAN. F SHOWN,
ELEVATIONS ARE REFERRED 10 N.0 V.D. OF 1929. THE CLOSURE IN THE 00UNWRY SURVEY IS
ABOVE 1:1 0000. THIS SURVEY IS POT' DBENDED FOR NEITHER OMEN FOR CONSTRUCTION PURPOSES.
FOR THOSE PURPOSES A TOPOGRAPHIC SURVEY IS REFIRED.
FENCE CMERSHIP NOT DETER/ ED
LAND SURVEYING INC.
5951 N.W. 151 Sit tt1 Suite 210
MIAMI LAKES, FL. 33014
P18.305) 823-3220 FAX: 305 823 -9808
Ut 7802
A.
LAND SURVEYOR AND MAPPER No. 5718
,SSUE OF FUMIDA
NOT VAUD VOTHOOT THE SNiIUIisE MD THE 01 CAL
R.OIMA UCENSED SURVEYOR AND MAPPER