PT-06-1552 Miami Shores Village 'JUN
FC,F-1VFD
Building Department zoos
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 (�
Tel:(305)795.2204 Fax:(305)756.8972
BUILDING Permit No.'I YO " � 2-
PERMIT APPLICATION Master Permit No.
FBC 2004 I=;,19 10c" ;F> P►,Y� ��G�� .
Permit Type(circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder) lJ ay 1 �'f �0 0 Phone# C3 o5_)
Owner's Address I D 4'0 o g ��awN\1-', N
City C1 i A`A l 51 f 0S State Zip 3 3 1 3 $
Tenant'Lessee Name Phone#
Job Address(where the work is being done) O 4-DO ~`tl u 0,4,(1) 4 v
City Miami Shores Village County Miami-Dade Zip 3 1 3g
FOLIO/PARCEL#
Is Building Historically Designated YES NO C
Contractor's Company Name ^j t (��j{Qua N Phone#_
Contractor's Address—%9 Cts JI i CK?,/\L-.) 1&Q
City `j J S i iQ State ` Zip 3 3 L S dr
Qualifier Name Phone#
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name(if applicable) hone#
GANG
o 0Value of Work For this Permit$ 5D b Square/Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration E]New [4 Repair/Replace ❑Demolition
Describe Work:
sx c'
Submittal Fee$ Permit Fee$ 19 -= CCF$ Q Cc 0 CO/CC
Notary$lES` Training/Education Fee$— - CrCD Technology Fee$.
Scanning S Radon$ DPBR$ Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.S Total Fee Now Due$ (=�7 -c30
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
inspection will not be approved and a reinspection fee will be charged
r
Signaturey f O Signature
Owner or Agent Contractor
The fore�oing^instrumeennt was a owledged before me this The foregoing instrument was acknowledged before me this
day ofl-^-��" C—,2tti_�by=rd 0
LK
ljiay of .20 by ,
who is personally known to me or who has produced who is personally known to me or who has produced
As ident1'g who did take an oath. as identification and who did take an oath.
LcAA
NO LIC-STATE(ft
NOTje
E%rleny a andez NOTARY PUBLIC:
Co ' 0 D476455
ares: 27,
Sign: n o: Sign:
Print: lit Print:
My Co . sion Expires: My Commission Expires:
APPLICATION APPROVED BY: Plans Examiner
Engineer
U� Zoning
(Revised 02/08106)
Miami Shores village
' Paint Color Approval and Agreement
Date
Owner's Name I)a T.
Phone#
f
Owner's Address ``V01
City
SU R F Sl a k State \ Zip 33 l 4
Job Address(where the work is being done) l D L,00 �L 1`X a,)�,t I 14V
City Miami Shores Village County Miami-Dade Zip
Is Building Historically Designated YES NO K
Contractor's Company Naive(if applicable) Phone#
All elements on the site must be listed and indicate the color to be painted
Walls
-7 OC -3 ®fit '0C sf41
I
Fascia
Drip Cap/drip/Edge �(
Soffit (U
Roof
Flower bins NE / s
Shutters---- /Q 760C-3
760C-3 P
Wild Honey
Awnings
Chimney
Doors and door jams ft
Garage doors
Railings 4
Fences )
Decorative metal
All brick(simulated or regular) l�
Stucco banding l
� 710C-3
Any other stucco features 1 Gobi Desert
Accessory Buildings l�
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.
Signature J�)a o� 66 �,y Date
Owner or Agent
APPLICATION APPROVED BY: ::�A
Date
P Z tcial chc 6/18/03