PT-07-84vo� Miami Shores Village
�
� 4Y■ Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
lEaMEVal
At JAN 1 7 2067
BY: VD'
BUILDING _ OZ, I0�]�;;.. Permit No. r 0 - 14
PERMIT APPLICATION
FBC 2004
Permit Type (circl
Building
1
Electrical P1
Master Permit No.
Mechanical Roofing
Owner's Name (Fee Simple ° older) 'Ilk%i1 C S t A 11 Phone #
Owner's Address q. Il J q t 0
City ► ` L..SL Stag Zip (.3
Tenant/Lessee Name
Phone #
7s-[ =342(3
Job Address (where the work is being done)
City t 01...Miami Shores Villa e
FOLIO / PARCEL #
Is Building Historically Designated YES
Contractor's Company Name
Contractor's Address
City
Qualifier Name ° ---- -'
b6 me ic)uoner
Phone #
State Zip
Phone #
Certificate of Competency No.
State Certificate or Registration No. 4 —�
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ 300 , CYO
Type of Work: DAddition / [Alteration
Describe Work:
Square / Linear Footage Of Work: --
e
Repair/Replace Q Demolition
IAA t .-C
*** ** * * *** *, *** * ** * * * * * **** * * * * ** *Fees********************************************
*********** * * * * * * * * * *�* * * * * * * * ***** ** * * * * **
Submittal Fee $ Permit Fee $ 2J . CCF $ 0 ' (OD CO /CC
Notary $ x0'00 Training/Education Fee $ 0-20 Technology Fee $ I 'D
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $
Structural Review. $
Double Fee $
Total Fee Now Due $ co-7'w
See Reverse 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 consttion au zoning.
"WARNING TO OWNER: YOUF
PAYING TWICE FOR IMPROVE
CONSULT WITH YOUR LENDER 0
COMMENCEMENT."
CORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,
ORNEY BEFORE RECORDING YOUR NOTICE OF
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
The for
dayo
known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
s ��� fir"'' g96
Sign: `_. �: � Sign:
Print: ,,x®.//14 f)J rJ ,�-r,r �M�'�5s�ob 2�;a� " Print:
My Commission Ex p ires:
xM My Commission Expires:
t*** ***** * ** **t*** *fir * ***t & *aY; *.,.5 ' :n "' *fie* sir ** qtr * **** *** * ** ** * ** **&**** **** qtr** **** ** *t, t, taY**,t*** * * ****** * *aY***
APPLICATION APPROVED BY:
(Revised 02/08/06)
Plans Examiner
Engineer
Zoning
Date:
Owner's Name:
Miami Shores Village
Paint Color Approval and Agreement
r ctivuL % I
Phone #. S _/ 3'126
9 /39 .�� - >n
Job Address (where the work is being done):
City: Miami Shores Village County:
Is Building historically Designated ?:
Contractor's Company Name (if applicable):
Walls:
Fascia: 1,
Drip Cap/Drip Edge: �ti44e,
Soffit:
Roof: W, r
Miami -Dade
YES
Zip: 3 CS
NO
Phone #:
All elements on the site must be listed and indicate the color to be painted
txttomi 104c-
Flower Bins:
Shutters:
Awning
Chimney:
Doors and Door Jams:
Garage Doors: �,(,14,4e)
Railings:
Fences:
Decorative Metal:
All brick (simulated or regular):
Stucco Banding:
Any other Stucco Features:
Accessory Buildings:
Other: �---
Attach color Samples
with numbers
•
290C -2 u
Creamy Beige
OWNER'S AFFIDAVIT: I ce -.Ty that all the foregoing information is accurate and that all work will be
done in compliance + . all icable law regulating construction and zonin
Date: /
Signature:
Owner or Agent
APPLICATION APPROVED BY:
Z OFFICIAL
Date: 310 Chi
* *MUST 13E ATTACHED WITH PURPLE BUILDING APPLICATION **