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BP-05-187 Miami Shores Village Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 t Tel: (305)795.2204 Fa . 972 BUILDING � �., � ��i1� Permit No. PERMIT APPLICATION TD Mas er Permit Na FBC 2001 Permit Type(circle): Building Electrical Plumbing Mechanical Roofing Owner's Name(Fee Simple hojlder) Phone# A -7S1 Owner's Address / ' �Shpt� Sta�� City-M f QX�1 � f te �.. Zip 3 3/3av Tenant/Lessee Name Phone# Job Address(where the work is being done) I V1 lP NG !®oC nd City Miami Shores Village County Miami-Dade Zip 3 3 / Is Building Historically Designated YES NO Contractor's Company Name N�l Q�.CJ/ ,,1/ Phone# Contractor's Address City State Zip Qualifier State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name(if applicable) Phone# $Value of Work For this Permit 0 0 0 cLEMTare Footage Of Work: T- fOif Type of Work: []Addition ❑Alteration ❑New E/Re air/Re lace �/ p p El Demolition Describe Work: TJX��n R 7k�� 1 0 r Submittal Fee$ Permit Fee$ 00 00 CCF$ c CO/CC Notary$ Q Training/Education Fee$ \ Technology Fee$ Scanning$ Radon $ Zoning Bond$ Code Enforcement$ Structural Plan Review. $ Total Fee Now Due$ 07- IqS6 (Continued on opposite side) 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 foregoin instrument was acknowled ed before me this The foregoing instrument was acknowledged before me this day of 2a by fJ > �., 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 P C: NOTARY PUBLIC: Sign: Mabel rg�� Sign: Commission DD2319�4 Print Print: :*= 9�oF F<°Q�� `;onded' '2007 Th uMires: My Commission Expires: `""I#('HondinQ c(-, trrr; y � APPLICATION APPROVED BY: Ag Plans Examiner Engineer LSC ZJU'� Zoning Chc 05/13/03 Miami Shores Village Paint Color Approval and Agreement Date S _ Owner's Name �`'?��� S/ ��� Phone# Owner's Address City S, State Zip Job Address(where the work is being done) �� � •�' � /ate sT 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 C �/ 4/ Fascia 6 16 Drip Cap/drip Edge Soffit Roof Flower bins Attach Color Samples Shutters With Numbers Awnings Chimney Doors and door jams Garage doors Railings Fences Decorative metal All brick(simulated or regular) Stucco bandin 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 applicable laws regulating construction and zoning. Date Signature Owner or Agent APPLICATION APPROVED BY: K:54� Date 02 /��d5 P&Z Offl � chc 6/18/03 OR Miami Shores Village Building Permit 10050 NE 2nd Avenue Phone: 305-795-2204 Permit Number: BP2005-187 �LrrRt Printed:2/25/2005 Page 1 of 1 - Applicant: MARY SMITH Owner: SMITH MARY JOB ADDRESS: 466 NE 102 ST Contractor Contractor's Address: Local Phone: Parcel # 1132060170560 Legal Description: AMD PL OF MIAMI SHORES SEC 4 PB 15-14 LOTS 3 &4 BLK 91 Fees: Description Amount FEE2005-2519 Building Painting Fee $60.00 Total Fees: $67.30 FEE2005-2520 CCF $0.60 ts:Total Receipts: FEE2005-2521 Notary Fee $5.00 p $0.00 FEE2005-2522 Training and Education Fee $0.20 FEE2005-2523 Technology Fee $1.50 Total Fees: $67.30 Permit Status: APPROVED Permit Expiration: 8/6/2005 Construction Value: $1,000.00 Work: PAINT EXTERIOR Q�\O Signed: (INSPECTOR) In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself,my agent,servants or employes. Signed: (Contractor or Builder) BY: