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PT-07-40BUILDING PERMIT APPLICATIO FBC 2004 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 79 . 04 Fax: (305) 756.8972 Permit Type (circle): 14S,ormit No. JAN 1 0 2007 B Y: --- - - - - -. P q--01-40 Master Permit No. Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) #06-k / ) Alf,e_cio Phone # 430„ Owner's Address / 5� City A1/44// SlieletS State zip 1 %3 f Tenant/Lessee Name , '4mE "9- SI 41-4® / Jam Phone # Job Address (where the work is being done) /69 ,Q City Miami Shores Village County FOLIO / PARCEL # ! l --312/ 06 ° ®1 a 1 Is Building Historically Designated YES Contractor's Company Name Contractor's Address ?% - • Pet eicivek -Dade zip ,3_3/31 Phone # City State Zip Phorit # Qualifier Name State Certificate or Registration No. Architect/Engineer's Name (if applicable) Value of Work For this Permit $ Type of Work: QAddition Describe Work: Certificate of Competency No. ihie40 Square / Linear Footage Of Work: ‘.1 104.1011 : "e - ^4° ❑ Repair/Replace ❑ Demolition ********** * * * * * * * * * * * * * * * * * * * * * * * * * * * *�YF Submittal Fee $ Permit Fee $ 620 j---� ' CCF $ Notary $ Training/Education Fee $ ©'.2O Scanning $ Radon $ DPBR $ Bond $ Code Enforcement $ Double Fee $ * * * * * * * * * * * * * ** CO /CC Technology Fee $ Zoning $ Structural Review. $ Total Fee Now Due $ See Reverse side -* itg4 c)PMD Bonding Company's Name (if applicable) __ - ` • s Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) /ieme /0 L/ Mortgage Lender's Address 3 0 0 g W ( `-� ' 0 6,0 City M a )l { f State )L C Zip .J ! (,),G.' 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 or Agent The foregoing instrument was acknowledged before me t day of OW... , 2007, by who is personally known.to or who has produced As identification and who did take an oath. NOTARY PUBLIC: Signature Contractor The foregoing instrument was acknowledged before me this 4Y of , 20 , by ly known to me or who has produced jfication and who did take an oath. Sign: Print: My Commission Expires:lr, /�� G2, n; * * ***** ********* * * ** * * ** ** *** *** **- * *** *' * * **** * * * **** APPLICATION APPROVED BY: (Revised 02/08/06) i/t Plans Examiner Engineer Zoning Date: Miami Shores Village Paint Color Approval and Agreement Owner's Name: A L) AIQ Phone #: 305-- 7 /b' Job Address (where the work is being done): L)E /®O City: Miami Shores Village County: Miami -Dade Zip: , ' '3 / 9 f Is Building Historically Designated ?: YES NO Contractor's Company Name (if applicable): ji.j,�4 Phone #: All elements on the site must be listed and indicate the color to be printed Drip Cap/Drip Edge: Soffit: S p F.-7- m /ST Roof: 49/WSW e d9■/ Flower Bins: ,(,7 Shutters: Awnings: Chimney: it) /1,9 i fleet) l Doors and Door Jams: feje,Od Garage Doors: 4 9 ti / I , /11 P�/ �'i /d4 J N% Railings: Fences: Decorative Metal: A /A}ek All brick (simulated or regular): Stucco Banding: Any other Stucco Features: Accessory Buildings: - Other: Attach color Samples with numbers CO /Ors /01/6"E� CW067W Soft Mist 8153M Hiking Path F20 OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance Ai all applicable laws regulating construction and zoning. Signature: C `�l) . c7 �` Date: Owner or Agent APPLICATION APPROVED BY: Date: * *MUST BE ATTACHED WITH PURPLE BUILDING APPLICATION ** Miami Shores Village °Jo) ituilu6' Building Department 621 m1c 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ' 7 ;L - Tel: (305) 795.2204 Fax: (305) 756.8972 v1 BUILDING RIECMEWM 0 '31 UI DING Permit No. JAN 1 0 2007 PERMIT APPLICATION By: AMA __ __ �� �� Master Permit No. FBC 2004 � Permit Type (circle Buildin Electrical Plumbing Owner's Name (Fee Simple Titleholder) © q' , ` uj 1l� Pia Owner's Address City M (a (. ' b y' es State L . Mec anical - CR�o(�ofing Phone # .2) 3 ®7 ^ l 7 Zip 9315 Tenant/Lessee Name Phone # Job Address (where the work is being done) CIA (R) tT Pt City Miami Shores Village County Miami -Dade Zip '3'31G-0 FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name Contractor's Address 71q Phone # City State Zip , ¢F) Qualifier Name Phone # 1 ', State Certificate or Registration No Certificate of CompetencNo rk. Phone # Architect/Engineer's Name (if applicable) Value of Work For this Permit $ % 0 Square / Linear Footage (Mk: Type of Work: ['Addition • Alteration Describe Work: AfTelz- tit/ 1f ❑ Re r/Replace ❑ Demolition ********* * *** * ** * * * * * * * * * *** * ** *** * * * * *F * * * * * * * * * * * * * * * ** * * * * * ** * * * * *x * * * * * * * *,r Submittal Fee $ Permit Fee $ • CCF $ a(C) CO /CC Notary $ Training/Education Fee $ 0' 7.0 Technology Fee $ / ° 3 Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side -* Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgaq Lender' aName 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 Al•'r'IDAVIT: 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. Signatu T Owner or Agent The foregoing instrument was acknowledge day of 7FFA , 20 , by On y { who is personally known to me or who has pr 1 6ZO 42.0 ° t4 3340 As identification and NOTARY PUBLIC: Sign: Print: My Commission Expires: Signature Contractor e me this t The foregoing instrument was acknowledged before me this a. , day of ,20 ,by o¢I al Pi LKGwho is personally known to me or who has produced e an oath. as identification and who did take an oath. NOTARY PUBLIC: Commission Expires: APPLICATION APPROVED BY: (Revised 02/08/06) Plans Examiner Engineer Zoning Date: Owner's Name: Miami Shores Village Paint Color Approval and Agreement Tptio:Ittvils 66?- Phone #: Job Address (where the work is being done): P41 °3 4) UJ 5137— 9?36 PI City: Miami Shores Village County: Is Building Historically Designated ?: Contractor's Company Name (if applicable): Miami -Dade Zip: -3'3 P5` YES AYA NO Phone #: All elements on the site must be listed and indicate the color to be printed Walls: /t r - Mt 1 W Fascia: Drip Cap/Drip Edge: Soffit: Roof: 010 ?''�: Flower Bins: Shutters: Awnings: Chimney: Doors and Door Jams: Garage Doors: N/R ityp snare Qs; (,U N/� N%4 NSA AVA Railings: Fences: Decorative Metal: All brick (simulated or regular): Stucco Banding: Any other Stucco Features: Accessory Buildings: Other: OWNER'S AFFIDAVIT: I certify that all a foregoing information is accurate and that all work will be done in comp ce with all applicable laws regulating construction and zoning. Signature: Date: APPLICATION APPROVED BY: 1 Date:_ Z O FICIAL 2,116,-) * *MUST BE ATTACHED WITH PURPLE BUILDING APPLICATION **