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PT-06-1428 Miami Shores Villagep TCCM97M Building Department MAY 2 6 2006 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 B Y:---- - ---------- BUILDING Permit No. Pro(o — I y 22) PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type(circle): Building Electrical Plumbing Mechanical Roofing Owner's Name(Fee Simple Titleholder) ALt=r'AN00 SCAAIACAL Phone# QIO zoo 1 Owner's Address LJ &,T A✓C 7 City /1/� ve/3 State0 O Zip Tenant/Lessee Name Phone# q Job Address(where the work is being done) U2 &co City Miami Shores Village County Miami-Dade Zip FOLIO/PARCEL# Is Building Historically Designated YES NO Contractor's Company Name / /6w 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$ la"� Square/Linear Footage Of Work: Type of Work: ❑Addition ❑Alteration New ❑ Repair/Replace ❑Demolition Describe Work: Submittal Fee$ Permit Fee$ l Q 0 �� CCF$ CO/CC Notary$ Training/Education Fee$ Technology Fee$ Scanning S Radon$ DPBR$ Zoning$ Bond$ Code Enforcement$ Double Fee$ Structural Review.$ Total Fee Now Due$ See Reverse side Bonding Company's Name(if applicable) Bonding Company's Address 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 inspectioInoth proved and a reinspectionfee will be charged. Signature Siwner or Agent Contractor The foregt was acknowledged before me this . The foregoing instrument was acknowledged before me this day of aC 20 by y of ,20 by o is personal own to me or who has produced �-- who is personally known to me or who has produced entification and who did take an oath. as identification and who did take an oath. NOTARY PU IC: T\irta NOTARY PUBLIC: Sign: Q Sig" Print: Print: My Co fission Expires: ,�y,• My Commission Expires: APPLICATION APPROVED BY: 3 l Y Plans Examiner Engineer Zoning (Revised 02/08/06) Miami Shores Village Paint Color Approval and Agreement Date S 2(0 U� Owner's NameT' r r� vv L Phone# Owner's Address `t Z( t\Jt City State Zip Job Address(where the work is being done) City Miami Shores Village County Miami-Dade Zip Is Building Historically Designated YES NO Contractor's Company Naive(if applicable) Phone# All elements on the site must be listed and indicate the color to be painted Walls Fascia 2 Drip Cap/dri Edge Z Soffit I/ Roof U 1t Cal Flower bins N f Shutters N - Awnings 1�) Chimney Doors and door jams 2 Garage doors N - O Railings ii N Fences l\1 I{� Decorative metal 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 applicablilawlation g construction and zoning. SignaturDate 41Z( ��� Owner or Agent J� I APPLIC RVED BY: \ Date P&Z Official chi 6n8iO3 " 4NCElUb