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BP-05-577 Miami Shores Village Building Department 4r v 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 BUILDING " Permit No. �PV '7 j 5 � '7 PERMIT APPLICATION �, a " /-U.. ster Permit No. FBC 2001 Permit Type (circle) Building Electrical Plung Mechanical Roofing Owner's Name(Fee Simple i er)J/l��'��iL/-&4�Ze 7ytClU Phone# ?d P— T,rco� TP Owner's Address c3j-z V1114- ld c9- S/- Cit jCity ?0 State Zip Tenant/Lessee Name Phone# Job Address(where the work is being done) e ol City Miami Shores Village County Miami '-Dade Zip 3 21 31 Is Building Historically Designated YES NO X �_ Contractor's Company Name Phone# Contractor's Address City Stat " Qualifier ` State Certificate or Registration No. Certificate of Competency No. Arch itect/Engineer's Name(if applicable) Phone# $Value of Work For this Permit 0,1Square Footage Of Work: Type of Work: ❑Addition ATAlteration []New ❑ Repair/Replace ❑Demolition Describe Work: ZY Submittal Fee$ Permit Fee$ � (�- ® CCF$ Notary$ '' Training/Education Fee$ h/` Technology Fee$ ® Scanning$ Radon$ Zoning Bond$ Code Enforcement$ Structural Plan Review.$ Total Fee Now Due$ (s✓ -7 , (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 approved and a reinspection fee will be charged. &alleSignature Signature Owner or Agent Contractor The fore oing instrument w, ackn wledged before me this cZe foregoing instrument was acknowledged before me this day y of 20_,by o is personally known to,me- r , ho has produced who is personally known to me or who has produced ttfication and who did take an oath. as identification and who did take an oath. NOTAR LIC: NOTARY PUBLIC: Sign: j Sign: 6amniirin �' ,:, ssion#DD323870 Print: inay 9jFod' Bonded Thra g My Commission Expires: „��� tlantic Bonding Co.,Inc. My Commission Expires: W APPLICATION APPROVED BY: Plans Examiner Engineer Zoning chc 05/13/03 Miami Shores Village Paint Color Approval and Agreement Date Owner's Name Phone# Owner's Address Cih' State Zip 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(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 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 applicable laws regulating construction and zoning. Date Signature Owner or Agent Date ' APPLICATION APPROVED BY: oho 6/18/03 P&Z Officials Miami Shores Village Building Permit 2n 10050 NE d Avenue Phone: 305-795-2204 Permit Number: BP2005-577 ` Printed:5/1212005 Page 1 of 1 Applicant: ANNELI DE CARVALHO Owner: CARVALHO ANNELI DE JOB ADDRESS: 356 NE 102 ST Contractor Contractor's Address: Local Phone: Parcel # 1132060135120 Legal Description: MIAMI SHORES SEC 1 AMD PB 10-70 LOTS 3&4 BLK 38 LOT SIZE 100.000 Fees: Description Amount FEE2005-5874 Building Painting Fee $60.00 Total Fees: $67.30 FEE2005-5875 CCF $0.60 Total Receipts: $67.30 FEE2005-5876 Training and Education Fee $0.20 FEE2005-5877 Technology Fee $1.50 FEE2005-5878 Notary Fee $5.00 Total Fees: $67.30 Permit Status: APPROVED Permit Expiration: 10/18/2005 Construction Value: $400.00 Work: PAINT HOUSE EXTERIOR 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 ct>nformity 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: