PT-06-1191 Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax: (305)756.8972
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BUILDING '' Permit No. - c
J� pJO2006
PERMIT AQTitleho4q(bF)
Master Permit No.
FBC 2004gY - -
Permit Type(circlect ' l Plumbing Mechanical Roofing
Owner's Name(Fee SI V-_ (VOA Phone# 7 3 `o I
Owner's Address 9�— /U Z: _ 7 J- c
city� r / State Al 6 Zip 333
IF
Tenant/Lessee Name Phone#
Job Address(where the work is being done) S-74
City,y[, 71 J_ Miami Shores Village County Miami-Dade Zip OSS 1 2 9
FOLIO/PARCEL#
Is Building Historically Designated YES O
Contractor's Company Name A i nPhone#'7�j'/ 7� 0
Contractor's Address 2
City State
Qualifier NameJe, ' Ali
J
State Certificate or rRistratil No. G( �j C7 ��'( Certi icate of Competency No.
Architect/Engineer's Name(if applicable) „ Phone# SVf ut
Value of Work For this Permit$ I , 'SOU Square/Linear Footage Of Work:
Type of Work: Addition Alterati n
YP ❑ ❑ o ew Repair/Replace ❑Demolition
Describe Work: � 2t✓� t. e C!D U S
Submittal Fee$ Permit Fee$ �� CCF$ ,- CO/CC
Notary$ Training/Education Fee$ C) • � Technology Fee
Scanning$ Radon$ DPBR$ Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due$
JUN 0ePAjVse side--+
r
i
Bonding Company's Name(if applicable)
Bonding Company's Address
City . State Zip
Mortgage Lender's Name(if applicable) L", /llCf Y�� h
Mortgagee Lender's Address X ! 7S
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 the recorded notice ofencement must be posted at the job site
for the first inspectio 'ch occurs seven (7) days after the building permit is issue . In the abs en of such po d notice, the
inspection will not e appy ved and a reinspection fee will be charged.
Signature Signature
Owner or Agent< ctor
The foregoing instrument was acknowledged before me this._ Th ing instrument was acknowledged before me this
day of 7 20 L by day of -1 20Q_6_,by !I—,—
who
who is personally known to me or who has produced , L who is pally known to me or who has produced_
As identification and o did take an oath. as identification.and who did take an oath,.
NOTARY P NOTARY PUBLIC:
020 LLORIN
Y
iSISION#002 „ GENEROZO
Si :ES:MAR 01 8
Sign:
MY COMM #DD295498
Sign:
Si s
Print: Print: �s �e nsu
My om ssion pires: mycorn ion pires:
APPLICATION APPROVED BY: _ Plans Examiner
Engineer
V ' Zoning
(Revised 02/08/06)
Miami Shores Village
Paint Color Approval and Agreement
Date ` �,, �.\
Owner's Name �.►i re Y�i�[ c ��� Phone# ' , 1-i9 i— �' � 6 j
C �L ► F3
Owner's Address �!Z
City (Y_�rw_� State { zip
Job Address(where the work is being done) >7
City Miami Shores Village County Miami-Dade Zip 33 13
Is Building Historically Designated YES _%
Contractor's Company Name(if applicable) Phone#�7 a) 2 cl 9[
All elements on the site must be listed and indicate the color to be painted
Walls
Fascia
Drip Cap/drip Edge
Soffit W vti r
Roof 1V
Flower bins des
Shutters
n
Awnings N 1n1
Chimney 1,1C
Doors and door jams
Garage doors l�!
Railings N NA
Fences --
Decorative metal
All brick(simulated or regular)
Stucco banding
Any other stucco features
Accessory Buildings V. 1'
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. j
Date
Signature
Owner or Agent
APPLICATION APPROVED BY: Date
P&Z Official cno 6/18/03
CANCEIIED