BP-05-608 Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
t Tel: (305)795.2204 Fax: (305)756.8972
BUILDING 17'R �, r� Permit No.
&OP
PERMIT APPLICATION Master Permit No
FBC 2001 _
Permit Type (circle): uilding Electrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder) IIQy- k&-`&YY1 Phone# 365 -7 � 15 3q
Owner's Address �� f�l�t� I C) -7 : l
City '"yWL0,YVLA _5Vl o re,_&ate V Zip 3 3I&o S
Tenant/Lessee Name Phone#
Job Address(where the work is being done) I lb D "1 151-
City Miami Shores Village County Miami-Dade Zip _-33) lvj
Is Building Historically Designated YES NO ✓
Contractor's Company Name Phone#
Contractor's Address
City State
Qualifier
State Certificate or Registration No. V "IfIbUompetency No
F7
Architect/Engineer's Name(if applicable) Phone#
$Value of Work For'this Permit /Q�" Square Footage Of Work:
Type of Work: ❑AdditionIteration ❑New ❑ Repair/Replace ❑Demolition
Describe Work: Q.L/�-�Z,yI�L �/L D Lk/2
Submittal Fee$ Permit Fee$ (��/ CCF$_& CO/CC
Notary$ n Training/Education Fee$ 0' 3 ) Technology Fee$
Scanning$ Radon$ Zoning Bond$
Code Enforcement$ Structural Plan Review.$
Total Fee Now Due$ lig �'
(Continued on opposite side)
r ,
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.
Signat re Signature
Owner or Agent Contractor
The f499
ument was ackno ledged before me this The foregoing instrument was acknowledged before me this
�,��
day o ,2004 .by `��, day of 20_,by
who is personally known to mJiffiLcation
as produced f� who is personally known to me or who has produced
8�id'w�eand who did take an oath. as identification and who did take an oath.
NO�n:
NOTARY PUBLIC:
tg ,,,,YP„. GinnyiIii Gonell
'. Commission#
"z Expire.' 26 2008
Bonded yTtuu
''�°��°
My Commission Expires: � �"� � At1anticltLyidffhvGmi6slon Expires:
APPLICATION APPROVED BY:
Plans Examiner
Engineer
Zoning
the 05/13/03
Miami Shores Village
} ' Paint Color Approval and Agreement
Date
Owner's Name Phone# J
Owner's Address 101
5'r
city1�1G��M__ V1.6Y1°.D
State PC, Zip
Job Address(where the work is being done)
City Miami Shores Village County Miami-Dade -Zip
Is Building Historically Designated YES NO 'l�
Contractor's Company Name(if applicable) Phone# _
All elements on the site must be listed and indicate the color to be painted
Walls D (,vYlea
Fascia
Drip Cap/drip Edge
Soffit
Roof
Flower bins Attach Color Samples
Shutters With Numbers
Awnings`
Chimney
Doors and door jams
i
Garage doors
Railings
Fences
Decorative metal
AtXI brick 1.(simulated or regular)
I
S[uC�3-�1'�n(�Ing r
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
Sigtiat4::j)��
Owner or Agent
C.r� Date
APPLICATION APPROVED Br �
PL L Offieia ch^611$/0
Miami Shores Village Building Permit
10050 NE 2nd Avenue
Phone: 305-795-2204 Permit Number: BP2005-608
Printed:5/12/2005 Page 1 of 1
Applicant: DIANE GRAHAM
Owner: GRAHAM DIANE
JOB ADDRESS: 18 NW 107 ST
Contractor Contractor's Address:
Local Phone:
Parcel # 1121360070020 Legal Description: DUNNINGS MIAMI SHORES EXT NO 3 PB 42-33 LOT 2 BLK
Fees: Description Amount
Building FEE2005-6005 u 9 Fee $60.00 Total Fees: $67.30
FEE2005 6006 CCF $0.60 P
Total Receipts: $67.30
FEE2005-6007 Notary Fee $5.00
FEE2005-6008 Training and Education Fee $0.20
FEE2005-6009 Technology Fee $1.50
Total Fees: $67.30
Permit Status: APPROVED Permit Expiration: 10/24/2005 Construction Value: $300.00
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
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:
Miami Shores Village Building P
10050 NE 2nd Avenue
Phone: 305-795-2204 Permit Number: BP2005-608
Printed:5/12/2005 Page 1 of 1
Applicant: DIANE GRAHAM
Owner: GRAHAM DIANE
JOB ADDRESS: 18 NW 107 ST
Contractor Contractor's Address:
Local Phone:
Parcel # 1121360070020 Legal Description: DUNNINGS MIAMI SHORES EXT NO 3 PB 42-33 LOT 2 BLK
Fees: Description Amount
FEE2005-6005 Building Fee $60.00 Total Fees: $67.30
FEE2005-6006 CCF $0.60 Total Receipts: $67.30
FEE2005-6007 Notary Fee $5.00
Education Fee 0.20
8 Training and $
FEE2005-600 9
FEE2005-6009 Technology Fee $1.50
Total Fees: $67.30
Permit Status: APPROVED Permit Expiration: 10/24/2005 Construction Value: $300.00
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
f Miami Shores Village. In accepting this permit I assume res onisibili for all work
conformity with the plans,drawings,statements or specifications submitted to the proper authorities o am S 9 P 9 P p tY
done by either myself,my agent,servants or employes.
Signed: (Contractor or Builder) BY: