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BP-05-1171 Miami Shores Village Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 BUILDING FSE E0IED Permit No. ' 1 1 PERMIT APPLICATI AUG 05 Master Permit No. FBC 2001 Permit Type(circle): uilding Electri R umbing Mechanical Roofing W Owner's Name(Fee Simple Titleholder) � ! R�� hone# ® �S Owner's Address g�3 City ,Q / ti� • S 1,-0<r_5 State l Zip 3 � Tenant/Lessee Name1'"�f}- Phone# Job Address(where the work is being done) City Miami Shores Village County Miami-Dade Zip Is Building Historically Designated YES NO Contractor's Company Name . Phone# Contractor's Address City State Zip Qualifier f.T: State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name(if applicable) Phone# p6 d $Value of Work For this Permit BBQ Square Footage Of Work: Type of Work: ❑Addition ❑Alteration ❑New ❑ Repair/Replace ❑Demolition Describe Work: Submittal Fee$ Permit Fee$ CCF$ ' CO/CC Notary$ —5• 00 Training/Education Fee$ o•2O Technology Fee$ • 50 Scanning$ Radon$ Zoning Bond$ Code Enforcement$ Structural Plan Review.$ Total Fee Now Due$ w a (Continued on opposite side) AUG 10 PAID Bonding Company's Name(if applicable) Bonding Company's Address L,- 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. �C Signatur Signature Owner or Agent Contractor The fore oing instrument was ack wledged before me this L11K The foregoing instrument was acknowledged before me this day of 20 ay of ,20_,by who is persoW own to or who has prod ed 2 who is personally known to me or who has produced As i e 'fi tion and who did take an oath. as identification and who did take an oath. NOTARY P BLIC: NOTARY PUBLIC: Sign: r�AG ab gas Sign: Print: °. EXP"r -3 2007 Print: of Fro on m My Com ission E pires: -Wan is 011dingcr,_,inc, My Commission Expires: /57 APPLICATION APPROVED BY: - Plans Examiner Engineer Zoning chc 05/13/03 Miami Shores Village • Paint Color Approval and Agreement Date Q 2 fly s /('0`f A- Phone# Owner's Name Owner's Address �r�3 1v� _ �1 )� A>Li t� 7S1'L,&5 State Zip ��/ 3& " Cityd--�T,_ .. Job Address(where�the work is being done)_ � 4-5 City Miami Shores Village County Miami-Dade Zip Is Building Historically Designated YES NO Contractor's Company Name(if applicable) Phone# All elements i�on the site must be listed and indicate the color to be painted Walls71 Fascia. G © U I U 7 I Drip Cap/drip Edge N_ Soffit a Roof Flower bins Attach Color Samples � � �� Shutters �- 0 v +� ��af - With Numbers Awnings Chimney Doors and door jams Garage doors A Railings Fences Decorative metal ej<S All brick(simulated or regular) s� j Stucco banding Any other stucco features G 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 re lating construction and zoning. Date Signature Owner or Agent Date � Zd-5-� , APPLICATION APPROVED BY: p&�Zi l ono 6/18/03