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PT-06-1321 �'5' 2 T5122 1 o& Miami Shores Village Building Department �• g p 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 BUILDING '�� Permit No.4 f PERMIT APPLI Y 1 9 2006 •t No. FBC 2004 _011K)T - Permit Type(circl )—Building lejrical Plu in echanical RoofingOwner's Name(Fee Sim er i21� � {�Y C4(XW 4 Phone# W� Owner's Address City tate VI' orZip Tenant/Lessee Name Phone# Job Address(where the work is being done) City Miami Shores Villa e 2 County hMiami-Dade Zip FOLIO/PARCEL# I �' i/ 7/ D Is Building Historically Designated YES NO G�hIED Contractors Company Name 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# Value of Work For this Permit$ V D�V Square/LinVeplir/Replace Work: Type of Work: ❑ dition ❑Alteration New Demolition Describe Wore �1Z YYI �' Submittal Fee$ Permit Fee$ (CK-)' CCF$—C,QQQ CO/CC Notary 5 (TLTTraining/Education Fee$ 0 Technology Fee$ Scanning$ Radon$_ DPBR$ Zoning$ Bond$ Code Enforcement$ Double Fee$ Structural Review.$ Total Fee Now Due$ G-7 - See Reverse side JUN 0 1 PAID Bonding Company's Name(if applicable) Bonding Company's Address City State Zip `• J 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. /,��Q �r► ��j� ' c �� V ��/t��^'w', 1, I-,I Signature G�/G ,. S�gnar�re Owner or Agent � Contractor The fol egoing instrument was owledged before me this ""1 The foregoing instrument was acknowledged before me this day o ,2 by N d 1Cb cLA LeiA:!::� ,20__,by who is persona own to me or who has produced who is personally known to me or who has produced As identif1 on an who did take an oath. as identification.and who did take an oath. NOT R PUB C: NOTARY PUBLIC: ndez Sign:Viak. e �` . Sign: V4.5 0A Print: 2 Print: TlltuAtlann BOn °''� M Commission Ex ires: My Commi sion Expires:L--_�Bonded - Y P APPLICATION APPROVED BY: l Plans Examiner Engineer (� Zoning (Revised 02/08/06) Miami Shores Village ` Paint Color Approval and Agreement Date_#*0 b, f3 V uO � Owner's Name [a n N^rnr A� 1�(�1'�1/1LG0 C�l�� J-v" Phone# Owner's Address 5 >� 5 � S 1 City V4 ;G 111 i State A V V4,�Gk- Zip Job Address(where the work is being done) 4S 00 G1 i9 ST City Miami Shores Village County Miami-Dade Zip Is Building Historically Designated YES NO X Contractor's Company Name(if applicable) OLA Phone# All elements on the site must be listed and indicate the color to be painted Wal Is QLS 2G�� cL V_C Q �� ZQ �d_�i lV► 6hu-EC_ Fascia Drip Cap/drip Edge Soffit Roof Flower bins y With Numbers Shutters Awnings Chimney Doors and door jams (/ L Garage doors Railings Fences S G(�(( 1 'or L,40 hi Decorative metal n<iiZ_ 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 laws regulating construction and zoning. f l Signature ;�1 Gl'h1(�� Date J O r or g nt �� APPLICATION APPROVED BY: Date P&Z Official clic 6/18/03 C' -- 1 r l �_ -- f � cZ r Miami Shores Village Paint Color Approval and Agreement Date 5 5 b6 Owner's Name j i� __Lbs t) Phone# �-sg -J 3a v Owner's Address 13 S City 19 .11 Slav u; State 1 D Zip Job Address(where the work is being done) 45- city 5City Miami Shores Village County M..iiaanii-Dade Zip Is Building Historically Designated YES NO Contractor's Company Name (if applicable) 62 / 14 Phone# All elements on the site must be listed and indicate the color to be painted Walls Fascia Drip Cap/drip Edge u�d Ufa 12) Roof J'`kD C1AMde Attach Color Samples Flower bins With Numbers Shutters Awnings Chimney u ' Doors and door jams p I I 1 Garage doors t �e/ ' ' `� (,1 tI W Y �M!11'I l 1�1� � ( Railings // Fences Lk9gOGI (,.e- d. 4� U ��U U/LQ� )qj� Decorative metal All brick(simulated or regular) Stucco banding Any other stucco features Accessory Buildings Other �JC ************************************************************************************************************ 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. � r / �iUw( GU 12r OYIC 6'L �'064��A—Datc Signature Owner or A t APPLICATION APPROVED BY: r _ Date P&Z Official clic 6/19/03 RIP ,M 300D i 30OD-4 r Hi • "Lto