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BP-04-959 Miami Shores Village RF(C � ¢� Building Department . j 1. 14 200, 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 �, . Tel: (305)795.2204 Fax: (305)756.8972 BUILDING Permit No. r q5q PERMIT APPLICATION Master Permit No. FBC 2001 Permit Type(circle): uildin Electrical Plumbing Mechanical Roofing Owner's Name(Fee Simple Titleholder) Ice Phone# 30S — D�L�~ CY 1143_ Owner's Address QoaS L-4t— �h— - City St= StateZip 3313 Tenant/Lessee Name G w?�e4 Phone# Job Address(where the work is being done) 610?—v City Miami Shores Village County Miami-Dade Zip '33 Is Building Historically Designated YES NO Contractor's Company Name Phone# Contractor's Address Aft CityState i d Zip Qualifier State Certificate or Registration No. Certific e of Competency No. Architect/Engineer's Name(if applicable) Phone# $Value of Work For this Permit /,-op Square Footage Of Work: 21 DO SC—, Type of Work: ❑Addition ❑Alteration ❑New Repair/Replace ❑Demolition Describe Work: �u,-Y;werf1y,` gii'n!� &,F— Submittal Submittal Fee$ Permit Fee$ t(1� ,Qy CCF$ �' CO/CC Notary$ '00Training/Education Fee$ _P 40 Technology Fee$ Scanning$ Radon $ Zoning Bond$ Code Enforcement$ Structural Plan Review.$ Due.Total Fee Now D u 'V _ (Continued on opposite side) Bonding Company's Name(if applicable) t A. Bonding Company's Address r , 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 Cie 'I : it with an estimated value exceeding$2500, the applicant must promise in goodfaith that a co o the notijkdays rent and construction lien law brochure chure will be p g f copy f delivered to the person whose property is subject to attachment. Alst1 ied copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven 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 )4 The foregoing instrument was acknowledged before me this day of ICAUVA, 200q ,by day of ,20_,by who is pers ally known to me or who has produced i^ who is personally known to me or who has produced As identifi i who did take an oath. as identification and who did take an oath. 1 001 Vargas NOTARY UB IC: ` omm ssion#l) 2314$4 NOTARY PUBLIC: 13,2 07 Sign: 9 F Sign. " AtInntic ding .Inc. Print: Print: My Commission Expires: My Commission Expires: APPLICATION APPROVED BY: / Plans Examiner �Q Engineer Zoning Chc 05/13/03 Miami Shores Village Paint Color Approval and Agreement Date " . 1 ' Owner s Name x _ nrl�� Phone# n Owner's Address C,,O`L� 1.tE City Nj c 'll t S State Zip Job Address(where the work is being done) City Miami Shores Village County Miami-Dade Zip 1 Is Building Historically Designated YES NO k--' Contractor's Company Name(if applicable) Phone# All elements on the site must be listed and indicate the color to be painted Walls ' Fascia Drip Cap/drip Edge Soffit Roof` Flower bins 1— Attach Color Samples Shutters With Numbers + Awnings r- Chimney Doors and door jams Garage doors Railings Fences Decorative metal All brick(simulated or regu ar) Stucco banding Any other stucco features V-A 0 Accessory Buildings 0­3 L) 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. Date 3/1q/Za:y --�=s•ice=—� Owner or Agent APPLICATION APPROVED BY: Date PBL Z Official chc 6/18!03