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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 **