BP-05-1362 Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 f
Tel:(305)795.2204 Fax:(305)756.8972
BUILDING :,!
Permit No. &o C5
PERMIT APPLICATION 1, SEPaster Permit No.
FBC 2001 3 &T"BFRa
Permit Type(circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder) \" Y/P Q S L Phone# Q� 7'J�"' 96-5-3
Owner's Address 0 -W 1 X 15
City Hi M�_ State
Tenant/Lessee Name 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_011)Al I_R Phone#
Contractor's Address
City State Zip
Qualifier AA
(114
4181T1&4
State Certificate or Registration No. F#Competency No.
Architect/Engineer's Name(if applicable) Phone#
$Value of Work For this Permit" aso,p O Square Footage Of Work:
Type of Work: ElAddition DAlteration FINew [ Repair/Replace
❑Demolition
Describe Work•
F?(Te12 r 0 A ir,IAF 1 1 tit G
Submittal Fee$ Permit Fee$ CCF'$ _(0_0 CO/CC
Notary$�50 Training/Education Fee$ 0. 20 Technology Fee$ C
Scanning$ Radon$ Zoning Bond
Code Enforcement$ Structural Plan Review.S
Total Fee Now Due$ b7 - 3
(Continued on opposite side)
Bonding Company's Name(if applicable)
Bonding Company's Address "
-y
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 i ection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection wil of be approved and a reinspection fee will be charged
Signature Signature
O er or Agent Contractor
The for ping instrument was acknowledged before me this IC The foregoing instrument was acknowledged before me this
day o��,20 by 'T lJZ-G� day of 120 by
who is personally k4no me or who has produced who is personally known to me or who has produced
As ' entification and who did take an oath. as identification and who did take an oath.
NOTARY P I NOTARY PUBLIC:
Sign: Si
Print: rVL Print:
My Commission pires My Commission Expires:
Y4APPLICATION APPROVED BY: V Plans Examiner
Engineer
Zoning
chc 05/13/03
ICN
Miami Shores illaw�
4
. - Paint Color Approval and Agreeinent
Date Iq 5 EP d 0�S
Owner's Name\Aos6 V�CZ Phone# 305 1-6-6-15-53
Owner's Address 96 1q,U) (O
p,� State FL Zip 331(og
.lob Address (where the work is being done) 4-rn 6-
city
City Miami Shores Village County Miami-Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name(if applicable)
Phone#
All elements on the site must be listed and indicate the color to be painted
Walls SEE p--T-WyCL ED Catop,
Fascia
Drip Cap/drip Edge
Soffit
Roof
Flower bins Attach Color Samples
With Numbers
Shutters
Awnings
Chimney
Doors and door jams
Garage doors
Railings
Fences
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
applicablelaws r ating construction and zoning.
Date N sc
Signature
Owner or Agent
�%�� —� Date l k�
AP°_ICATI`?N APPROVED BY: crico/t9/C`