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BP-2003-155 Miami Shores Village Building Department 10050 N.E2nd Avenue R 9 V E® Miami Shores,Florida 33138 Tel:(305)795.2204 LSSEP 5 �0�3 Fax:(305)756.8972 BUILDING. - ---- -- Permit No. �ZC PERMIT APPLICATION Master Permit No. FBC 2001 Permit Type(circle): (titleld ing, Electrical Plumbing Mechanical Roofing c C� Owner's Name(Fee Simple er) lJ\J s I II� M � �° Phone# Owner's Address f S 1".j LT- q City .Nit -1,,, S IN°° ) State. rz Zip Tenant/Lessee Name Phone# Job Address(where the work is being done) City Miami Shares Village County Miami-Dade Zip Is Building Historically Designated YES NO, Contractor's Company Name Phone# Contractor's Address City State Zip Qualifier Architect/Engineer's Name(if applicable) - Phone# Architect/Engineer's Address City State Zip $Value of Work For thi$Permit =`�'� Squar 'a e Of rk: i Number of:Bays _ Stories Families Baths Type of Work: DAddition DAlteration DNe Repair/Replace ❑Demolition Describe Work: co County Escrow Fee$ Permit Fee$ Notary$ g Education/Training Fee$j Tech$ Scanning$ Radon$ Code Enforcement$ I " Bond$ Struct.$ on opposite side)) Due (Con pp Total'Fee Now $ M ' us Plans Check Feet$ - 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$2500, the applicant must promise in goods sub that a copy of the whose property i notice of commencement and construction lien law brochure will be delivered to the person s subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection wit not b approved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of------_,20_,by day of 20 by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Punt:. Sign. Print My Commission Expires: MY Commission Expires: (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. *�**�***r***ss�s4►**s*�+r*+r�*��*�*�*$*s**�***�#+��*��*****+*xut*�*�***� *+x�*�*��**�►***era*******ss*�sr�*�+r s � APPLICATION APPROVED BY: SEP 2 9 2003 p Engineer a chc717/03 Zoning MIAM I SHORES VILLAGE Paint Color Approval and Agreement ' DATE: 91 �' � /a 3 � - OWNER'S NAME PHONE: ��6 ZSL .`71is- : ADDRESS OF SITE: CONTRACTOR&LICENSE (if applicable) PHONE: COMPANY NAME: All Elements on the site must be listed and indicate the color to be painted. �. Walls C.r�e.r-i, �L L� ►� f Fascia Drip Cap/Drip Edge Soffit _ Roof o ' l h Flower Bins E Shutters Awnings Chimney Doors and door jams w Garage Doors .-, Railings - t$ © 2.155-60 r, -Fences � T Decorative Metal ; j All brick(simulated or regular) !L\A,' Stucco Banding Any other stucco features Accessory Buildings Other t all the foregoing information is accurate OWNER S AFFIDAVIT: I certify that g and that all work will be done in compliance with all applicable laws regulating able,to construction and zoning. I authorize the above-named contractor, to - be as-per the attached will P e work stated.Furthermore the paint colors _ do the ature of Owner Date Signature of Contrao >k >r<D >x*>� ign APPROVED:- WHEN PR INSPE CON CALL FOR FINAL - :fie 4/23/01 Date Building Offici 1 AU6 2 9 263 A-v- n f � _ - 41 f 4-k af 4-he pe m,4 4.4 tw-e JLZ-q4r-� --IVLCAAI-J, 3 1 e c M, J--Mmtfil - �� yv)