PT-07-376Miami Shores Village 0310510,7;,;__
Building Department Let;a.•
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING M M O ME `Urg Permit No.
PERMIT APPLICATION r I. ter Permit No.
FBC 2004 as FEB r 2 7 1007
BY: i/ biAc
Permit Type (circle): Building Electrical hfumbitig" Mechanical
cyj' 31-b
Roofing
Owner's Name (Fee Simple Titleholder) 6'6,119 + Nick 6 age r+ Phone # 305 -156-9213
Owner's Address to 01 f rand. Con C o (Arse
J
City Ml'0.4wi ..S ores State Ft-
Tenant/Lessee Name
13138
Phone #
Job Address (where the work is being done
City Miami Shores Village
FOLIO / PARCEL #
loo ! Gran
County
Is Building Historically Designated YES
j,onCOitrsa
ade
Zip 33 1 3$
fir. q
Contractor's Company Name H e L7 /' �S a "/ ' ' n Phone # (os') 079 q - 7 3 I. i
Contractor's Address /5-4,242 v � o� i 1'A c.e.
City Moles ',Lea i State , Zip 33033
Phone #
State Certificate or Registration No. Certificate of Competency No.
Qualifier Name
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ l 000
Type oaf Work: ❑Addition
Describe Work
Ai 4
❑Alteration
Square / Linear Footage Of Work:
❑New
❑ Repair/Replace
Demolition
1
colons
a i'
* * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $
Notary $ 6W
* * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
CCF $ 193 CO /CC
Technology Fee $ )
Zoning $
'cI
Training/Education Fee $ 1100
Scanning $ Radon $
Bond $ Code Enforcement $
DPBR $
Double Fee $
Structural Review. $ Total Fee Now Due $ 7® '
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 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 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 /l% * «' irs ` Signa �: `'�
If
or Agent a r Contractor
The foregoing instrument was acknowledged before me this ie d'�regosnstrument was acknowledged before me this
day of FC6 , 2007, by f(/ at(DS cevt da ht �14 20 01, by Heavy avy S' Valdez;
who is personally known to me or who has produced g, f�i►(✓Utl who is personally known to me or who has produced
i. <<— As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
*** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
as identification and who did take an oath.
NOTARY PUBLIC:
APPLICATION APPROVED BY:
(Revised 02/08/06)
**** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
,,,,,, MAR RET S..,
Notary Public - State of Florida
es of a�509
a#pp 0
' Bonded By National Notary Assn.
2-1221 ( a-1
Plans Examiner
Engineer
Zoning
Oe.
ect‘j`' °
\<rnefte
Flo NIA
Miami Shores Village
Paint Color Approval and Agreement
Date: ,R-26- 0 7
Owner's Name: 6(411 # Att.. ijO t 44 Phone #: 3 0 ..; S7.0 —'t )3
Job Address (where the work is being done): 60( Gro -rtzt ra t G u .roc
City: Miami Shores Village County: Miagni -Da ip: 13a7
Is Building Historically Designated ?: YES' NO
Contractor's Company Name (if applicable): -for Va. Phone #: 3 05- 2 (17 -73 ?/
Walls:
Fascia.
All elements on the site must be listed and indica
A f°factC�. \*"
Drip Cap/Drip Edge:
Soffit:
Roof:
Flower Bins:
W %cc tic
Shutters: k) t 4-e_
e the color to be painted
Awnings:
Chimney: Tic1/41
Doors and Door Jams: Mors - tQ pod ! Ja• wks -
Garage Doors:
Railings:
Fences:
Decorative Metal: a )—e-
All brick (simulated or regular):
Stucco Banding: IA) ( +e 0.1
Any other Stucco Features: (,c) 1,1:4-e_ a `fie a.
Accessory Buildings: )01. Yl K /Peac.L
Other: 6104 °- 12 ° ZP c OOc--- )\
0
ere.24,
Attach color Samples
with numbers
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work
done in comce with all applicable laws regulating construction and zoning.
Signature:
Date:
APPLICATION APPROVED BY:
P.8'c Z OFFICIAL
* *MUST BE ATTACHED WITH P
Date: 1 °'
LE BUILDING APPLICATION **