BP-05-765 Miami Shores Village -��
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Te.L3051795.2204 Fax:(305)756.8972
BUILDING Permit No. RP65-- 765-
PERMIT
GSPERMIT APPLICATIo Master Permit No.
FBC 2001
Permit Type (circle): Building Electrical Plumbing Mechanical Rooing
Owner's Name(Fee Simple Titleholder) Phone#� 7 -7
Owner's Address .3/ /44 E )
City1,9, � State l Zip 1
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 OJ V1 e�- Phone#
Contractor's Address
City VANUUM Zip
Qualifier
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name(if applicable) / Phone#
$Value of Work For this Permit 1, Square Footage Of Work:
Type of Work: ❑Addition ❑Alteration ❑New ❑ Repair/Replace
❑Demolition
Descri a tW rk: AV
,,*�*'\
Submittal Fee$ Permit Fee$ &y -®o CCF$ CO/CC
Notary$ _�_ Training/Education Fee$ Technology Fee$ A so
Scanning$ Radon$ Zoning Bond $
Code Enforcement$ Structural Plan Review.$
Total Fee Now Due$ P Cj h
�
�ll .AY 2 4 PROD
(Continued on opposite side) 7
C. C',
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 n be approved and einspech n fee wil be charged.
Signature I Signature
Own gent Contractor
The for eg 'ng instrument was acknowledg before me this The foregoing instrument was acknowledged before me this
-4
day of ,20(f�),by } EQ day of 20_,by
who is pe rs al y nown to me or who has produced�Q 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.
NOTA PU IC: `Tarr NOTARY PUBLIC:
Sign: y � �l /y Sign:
Print: °�Fl o!A. - tss� Print:
M C mmission E ares: s�b
Y p ; 9My Commission Expires:
APPLICATION APPROVED BY: Plans Examiner
Engineer
Zoning
chc 05/13/03
Miami Shores Village
Paint Color Approval and Agreement
Date �-7 �+�
Owner's Name , ' Phone# �y /5�3 "
Owner's Address—
Ci,y_4&JLtqA4State Zip
Job Address(where the work is being done)
CityMiami 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 Sdmples
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
F
liance with all
OWNER'S AFFIDAVIT. I certify that all the foregoing information is accurate and that all work will be done in coin
applicable laws regulating construction d zoning.
Date
Signature
s
Owner or Agent
� � ► jr
APPLICATION APPROVED BY:
Date � �-`+r` C)
P&Z Official chc 6/18/03