PT-7-609BUILDING
PERMIT APPLICATIO
FBC 2004
Permit Type (circle
Owner's Address � - � 1 N t 91 °
Cit MC Zwt,e S Wo rCS State ? L
Tenant/Lessee Name
uildin
Job Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL # ¶ Lp 1 -3 ag)-+1 -c • 1 00 - 10
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's Address
i lY
Value of Work For this Permit $ 0
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
hcA a .
Electrical Plumbing
t1S/ t1E: `'`d S+rcet
County Miami -Dade
APR 0 2 2007 n p1 e ���
Permit No.
Master Permit No.
MVFE
MAR 282007 g
BY: - -.
S+f 'i•60R
zip 33138
Phone #
Mechanical Roofing
Owner's Name (Fee Simple Titleholder) ? -TT c A `� - Phone # 3i7 �' l 0 ' ! S
zip 33 138
(? Pi Azo.u.z Slurs 4.c..l M t$ (h. f 1 e
Phone #
City State Zip
Qualifier Name Phone #
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Square / Linear Footage Of Work:
„7 .
Type of Work: DAddition 0Alteration N e w D Repair/Replace 0 Demolition
Describe Work:
Submittal Fee $ Permit Fee $ ll0 0_ CCF $ 0 CO /CC
Notary $ Training/Education Fee $ Technology Fee $ 1 •50
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $ n
Structural Review. $ Total Fee Now Due $ &9 - ZO .
See Reverse side -*
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mo der' xf a licable)
Mort ag dr ' A ddrest ' '
• 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
Owner orent Contractor
The foregoing instrument was acknowledged before me this !Z. The foregoing instrument was acknowledged before me this
day of tot , 20 01 by at • 'U' A J . Y W+- 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.
Print: ao o,;; P LYNN B. LEWIS
MY COMMISSION # UU 3i/IUt
M y Commission Expires: p * '( q;i ,g * EXPIRES: April 8, 2009
aj gr $°$ Bonded Thor Budget Notary Services
APPLICATION APPROVED BY:
(Revised 02/08/06)
NOTARY PUBLIC:
i 7,31()
Signature
Sign:
Print:
My Commission Expires:
Plans Examiner
Engineer
Zoning
Miami Shores Village
Paint Color Approval and Agreement
Date:
Owner's Name: 7 1CZL ‘ i jvl A-IQ Phone #: 3o S ' � c i r3 • r ig 4 S'
1151 1•c cq S-h-C .f
Job Address (where the work is being done):
City_ Miami Shores Village County: Miami -Dade Zip: 31 1 3
Is Building Historically Designated ?: YES NO
Contractor's Company Name (if applicable): Phone #:
Walls:
Fascia:
Drip Cap/Drip Edge:
Soffit:
Roof:
Chimney:
Doors and Door Jams:
Garage Doors:
Railings:
Fences:
Decorative Metal:
All elements on the site must be listed and indicate the color to be printed
All brick (simulated or regular):
Stucco Banding:
Any other Stucco Features:
Accessory Buildings:
Other:
APPLICATION APPROVED
Flower Bins:
Shutters:
Awnings:
Owner or
p
OWNER'S AFFIDAVIT: I certify that all the
done in complian th all applicable laws r
Signature: )‘.
foregoing information is accurate and .th all 'ork will be
lating construction and zoning, . '�.t �► S
a�` 4 1 .. ° ,moo LYNN B. LEWIS
Date: * = c + * OMMISSION # 00 377701
P Z OFFICIAL
ACRYLUX PAINT
MFG. CO
100% ACRYLIC Since 1959
100% ACRYLIC ROOF COATING
DURABLE MILDEW RESISTANT FINISH
SATIN — FLAT SEMI -GLOSS
WHITE
01. CXPIRCS: April 8, 2009
.nrq � �� Banded Yh i Buid et Notary Services
Date: 3 cf - 7
* *MUST BE ATTACHED WITH PURPLE BUILDING APPLICATION **
Attach color Samples
with numbers
Owner Information
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Project Address
1151 NE 99 Street
Miami Shores Village, FL
1132050180070
Block: Lot:
PATRICIA FREEMAN
Address
1151 NE 99 ST
MIAMI SHORES FL 33138 -2640
Contractor(s)
HOME OWNER
Type of Work: Exterior
Color: WHITE
Additional Info:
Classification: Residential
Color. WHITE Approved
Color. WHITE Approved
Code Comments: ROOF - WHITE
Color. WHITE Denied
Fees Due
CCF
Education Surcharge
Permit Fee
Technology Fee
Total:
Amount
$0.60
$0.20
$60.00
$1.50
$62.30
Building Department Copy
Thursday, March 29, 2007
Expiration: 09/25/2007
Parcel Number
Total
$ 0.00 $ 0.00
Payment Type:
Amt Paid I Amt Due
$ 0.00
0241 APR 0 2 2007 LJ
F3 Y:
Authorized Signature: Owner / Applicant / Contractor / Agent
Phone
Applicant
Valuation:
Total Sq Feet:
March 29, 2007
Date
Cell
33333333:83333:.' .B.MZ'9ffi's£1,1.81<WVMMIAMS<VPBWfflnffiMVRMWARMMM
$ 1,00
0
Available Inspections:
Inspection Type:
Final
1
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 responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated.
1