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PT-06-1235 Miami Shores Village y � �d 33 Building Department artment - 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax: (305)756.8972 BUILDING Permit No. R-dg— I�3� PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type(circle) Building _ Electrical Plumbing Mechanical Roofing Owner's Name(Fee Simple Titleholder) 4 11"21,;iN >C1/v Phone# Owner's Address / — City/� -'�"'(l 5 L"t<t7.Fi.5 State Zip 'S 3, Tenant/ ,essee Name Phone# Job Address(where the work.is being done) 6 U J AO / Sa City Miami Shores Villaee County . Miami-Dade Zip FOLIO/PARCEL# Is Building Historically Designated YES NO Contractor's Company Name iPhone# Contractor's Address City State Zip Qualifier Name Phone# State Certificate or Registration No. Elompetency No. Architect/Engineer's Name(if applicable) Phone# !jam' Value of Work For this Permit S Gv© Square/Linear Footage Of Work: � g Type of Work: ❑Addition ❑Alteration ❑New ❑ Repair/Replace El Demolition Describe Work: Submittal Fee$ Q Permit Fee$(o CCF$ CO/CC Notmr - 00 ' Training/Education Fee Technology Fee$ ( . Scanning$ Radon$ DPBR$ Zoning$ Bond$ Code Enforcement$ Double Fee$ Structural Review.$ Total Fee Now Due$ Lo , See Ortsdir �K X03 Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) /�� CLF-1 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 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. i Signaturq,�_��__,; ` Signature �, er gO or A ent Contractor The foregoing instrument was ac owledged before The foregoing instrument was acknowledged before me this day of Ik -'�-1 ,2( by C �, y of .20 by , who is personally known to me r ho has produced who is personally known to me or who has produced WA , As identification and who did take an oath. as identification.and who did take an oath. NOTAR PUB C: NOTARY PUBLIC: N Sign: Sign: 5 Print: r Print: My m iss n Expire Z'Z' 7 c l My Commission Expires: APPLICATION APPROVED BY: "Y Plans Examiner Engineer f (O Zoning (Revised 02/08/06) Miami Shores Village Paint Color Approval and Agreement Date. Owner's Name -T i<_.;•3 1J Phon Owner's Address City 6. zip State Job Address(where the work is being done) 1� -7 City Nfi2rru Shores Village —County Miami-Dade -Zip Is Building Historically Designated YES— (NOS Contractor's Company Name (if applicable) Phone All elements on the site must be listed and indicate the color to be painted Walls Fascia Drip Cap/drip Edge Soffit Roo BODY Flower bins L Awnings Chimney Doors and door jams Garage doors Railings A Fences of AL C- ACCINT + Decorative metal All brick(simulated or regular) I tw Stucco banding Any other stucco features 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. Date Signature Owner or Agent Date APPLICATION APPROVED BY: Z icial dic 6/18/03 � ELLED �•" i �_ C�34Y2 d - r �1 C i =:,...f;i:=ii.II