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PT-06-1237 Miami Shores Village ` Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 pY­n � C� �C46Tel: (305)795.2204 Fax:(305)756.8972 BUILDING l CP,TVF� Permit No. PERMIT APPLICATIO �Fl_ YZ��F Master Permit No. FBC 2004 Y. Permit Type(circ Building Electrical Plumbing Mechanical Roofing r Owner's Name(Fee Srrimgqple Tit e o der) Y �./ill� v Vo on �� Owner's Address V � -� '` CityP V 1 V C�State rr� f Zip E�5) Tenant/Lessee Name Phone# Job Address(where the work is being done�__�n�. City Miami Shores Village County Miami-Dade Zip FOLIO/PARCEL# Is Building Historically Designated YES NO Contractor's Company Name ' Wr�J Phone# Contractor's Address City State Zip Qualifier Name Phone# State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name(if applicable) Phone# //�� CLED Value of Work For this Permit$ % 1V Square/Linear Footage Of Work: Type of Work: Ad ' ion yp dyl � ❑Alterationew ❑ Repair/Replace ❑Demolition Describe Work: Submittal Fee$ Permit Fee$—(.00 CCF$ d CO/CC Notary Training/Education Fee$ Q. d v Technology Fee$ .. Scanning$ Radon$ DPBR$ Zoning$ Bond$ Code Enforcement$ Double Fee$ Structural Review.$ Total Fee Now Due$ See Reverse side -> q Bonding Company's Name(if applicable) Bonding Company's Address r 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 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. Signa Signature Owner or A nt Contractor The foregoi M'nstrument/was acknowledged before me this � n� The foregoing instrument was acknowledged before me this day of ,26(?by fJ�v.,rl day of .20 by who is persona own to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification.and who did take an oath. $soffit' NOTARY PUBLIC: NOTARY PUBL �,•�! ►r''% Sign: Sign: Print: '9�i ✓ /}al' Print: My Comm' Sion Expires: p�i, ��yj My Commission Expires: APPLICATION APPROVED BY: 6 Plans Examiner / Engineer Ly l OL Zoning (Revised 02/08/06) Miami Shores Village Paint Color Approval and Agreement Date r ( . Owner's Name LS Phone# ,�� j—:25 Owner's Address City �� ( Y�� State — Zip ` Job Address(where the work is being done) -So y i City ami Shores Village County Mi Dade MiZip Is Building Historically Designated YES NO Contractor's Company Name(if applicable) Phone# All elements on the site must be listed and indicate the color to be painted Walls Q Fascia C� Drip Cap/drip Edge Soffit I Roof_ Flower bins -' Shutters Awnings Chimney Doors and door jams VYV Garage doors Railings ti Fences ( Q. � Q Decorative metal r All brick(simulated or regular) 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 law lating construction and zoning. Date S l 0 Signat �� Owner or Agent ....., T-1 ffloe APPLICATION APPROVED BY: Date P&Z Officialchc 6/18/03 CANCELLE u