PT-07-1149v
Amount
CCF
Miami Shores Village
Education Surcharge
10050 N.E. 2nd Avenue
Permit Fee
Miami Shores, FL 33138-0000
Technology Fee
Phone: (305)795-2204
Total:
$65.50
Project Address Parcel Number Applicant
823 NE 96 Street 1132060142790
JOSE RODRIGUEZ
Miami Shores Village, FL t: 33138- Block: Lot
Owner Information Address Phone Cell
JOSE RODRIGUEZ 823 NE 96 ST
MIAMI SHORES FL 33138-2521
Contractor(s) Phone Cell Phone
DESIGN REMODELING & CONSTRUC'
of Work: Exterior
: SQUIRE HILL BUFF/BRILLIANT WHITE
ional Info:
6cation: Residential
SQUIRE HILL BUFFBRILLIANT WHITE Approved
SQUIRE HILL BUFFBRILLIANT
Valuation: $ 4,500.00
Total Sq Feet: 0
Code Comments: BEN MOORE - WALLS - SQUIRE
Color: SQUIRE HILL BUFF/BRILLIANT
Fees Due
Amount
CCF
$3.00
Education Surcharge
$1.00
Permit Fee
$60.00
Technology Fee
$1.50
Total:
$65.50
Total Amt Paid Amt Due
$ 0.00 $ 0.00 $ 0.00
Payment Type:
PAID
Available Inspections:
Inspection Type:
Final
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.
June 06, 2007
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
Wednesday, June 6, 2007 1
Miami Shores Village
Building Department artment
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: P_ --.---_.
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: PAINT PERMIT
Permit No. P M - I WAH
Master Permit No.
Owner's Name (Fee Simple Titleholder) �� ��„�„� tr,, Phone # 7*r, grnn 3,pG 3
Owner's Address 52A L4C' ax" r-AS=_Q4.3u s rB E' r�r
City_M44n„ mAo,p� � State t`L_0j&k0a Zip X3 8
Tenant/Lessee Name
E-MAIL:
Phone #
Job Address (where the work is being done) 82"-5 N (- C1 G 3- "
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES NO
__)�_
Contractor's Company
City_
Qualifier Name
State Certificate or
OWNER BUILDER:
Value of Work For this
Describe Work:
tom..%e�l�ir . -
_Zip a S� G�
Phone # 70 S' /� 09
No. % 19/ 1 �11 --:F- % Certificate of Competency No.
&12—
, Type of Work: [] Addition / ❑
YES/NO
I Repair/Replacer
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 ofa 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.....
"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
notice of commencemen.
of commencement must
inspection will not be ax
Permit Fee $ VA)
Training/Education Fee $ 1 .�
Double Fee $ Zoning $
Pnwe an estimated value exceeding $2500, the applicant must promise in goodfaith that a copy of the
r to the person whose property is subject to attachment. Also, a certified copy of the recorded notice
je ccurs seven (7) days after the building permit is issued. In the absence ofsuch posted notice, the
S
Technology Fee: i - so
Notary $ Code Enforcement $/' `
Total Fee Now Due $ IUE,SL
See Reverse side
PAINT COLOR APPROVAL AND AGREEMENT
All elements on the site must be listed and indicate
the color to be painted
Directions: Please circle corresponding number to appropriate
color sample
Walls: 1 2
3
4
Attach color samples with name
Fascia: 1 12
3
4
Drip Cap/Drip Edge: _1 2 3-----4
Soffit: 1 2
3
4
1
Roof: 1 2 3 4
Flower Bins:_1 2 3 4
Shutters: 1 2
3
4
squif-
ante u q :r�, nT
Awnings:
-1-2-3-4
Chimney: 1
3---4
Doors and Door Jams: 1 n
3
4
Garage Doors: 1
3
4
Railings: 1 2
3
4
3
Fences: 1 2
3
4
of br;tuant white
All brick (simulated or regular): 1
2 -3
-4 --
34Stucco
btancok !tante
Stucco Banding: 1 2
3
4
Any other Stucco Features:23
4
_1
4
Accessory Buildings
Other:
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.
OS�SB �b� €;
Signature Signature
wne r Agent
The foregoing instrument was acknowledged before me this
day of , 20 _, by
who is person own to r who has produced
p
As identifi tion and who did take an oath.
NOTARY
Sign:
My Cortimis iT S. My Commission DD669356
Expires 0510112011
APPLICATION APPROVED BY:
f Contractor
The for ng instrument was acknowlSaged before m4ee1-174
day of 20 lfl�p *1, by
who isersonally known to me or who has produced P
as ide tification and who did to an oath.
NOTARY PUBL
Sign:
Print:
r
My Commi tv
MAMCOOO OOMgIp
"fty ANo • 8hN d r
C oe #0041a"44
NdM
Plans Examiner
Preservation Board
Code Enforcement
(Revised 04/24/07)