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PT-06-1589 Miami Shores Village g �cFTVFD Building Department JUN 1 9 ?nns 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 I Tel:(305)795.2204 Fax:(305)756.8972 BUILDING Permit No. PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type(circl Building Electri 1 Plumbing Me apical Roofing Owner's Name( Simple Tit e oder W S Phone# J J Owner's AddressssIL4 C4 111 li�7 1 , C�` 1-1 �l �'f 4L State Tenant/Lessee Name Phone Job Address(where the work is being done City Miami Shores Village County Miami-Dade Zip FOLIO/PARCEL# Is Building Historically Designated YES O Contractor's Company Name �� Phone# Contractor's City Zip Qualifier Name Phone# State Certificate or egis anon o. Certificate of Competency No. Architect/Engineer's Name(if applicable) Phone# Value of Work For this Permit$ ���� Square/Linear Footage Of Work.•n : Jv S ro Ll„6 Type of Work:. Addition ❑Alteration ❑New J ]Repair/Replace El\ Demolition Describe Work. 1 Submittal Fee$ Permit Fee$ CCF$ CD. CO/CC Notary$ Training/Education Fee$ Technology Fee$ ( � Scanning$ Radon$ DPBR$ Zoning$_ Bond$ Code Enforcement$ Double Fee$ /�++� Structural Review.$ Total Fee Now ue$ G-7 •a C ee Reverse bide—j� Bonding Company's Name(if applicable) Y 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 insecIf which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will t be approved and a reinspection fee will be charged Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledger�dbefore me its 1Z The foregoing instrument was acknowledged before me this day of 20C�,by �ftyd `NW day of ,20__,by , who is personally known 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. NOTARY PUBLIC: NOTARY PUBLIC: MYC0 LISS# WZ SSIpW t DD 483M Sign: ` Sign: Print: XI ' Print: My Commission Expires: "" My Commission Expires: APPLICATION APPROVED BY: �/ C/ Plans Examiner on / Engineer c 3 t Zoning (Revised 02/08/06) Miami Shores Village Paint Color Approval and Agreement Date /' Phone Owner's Name I-,' . 7 Owner's Address \ CiA , 1�7� State Zi Job Address(where the work is being done) Miami Shores Villaae�rTt� \ Co 'ami-Dade Zip 7 Is Building Historically Designated YES NO Contractor's Company Name (if applicable) o}(�(� . Phone# \ All elements on the site must be listed and indicate the color to be painted Wal Is J Fascia Drip Cap/drip Edge h/ u Soffit S Roof v Flower bins U 4 Z ��~' \ :tach Color Samples Shutter sV \ With Numbers Awnings �� V Chimney Doors and door jams Garage doors z.-a �— Railings �� Fences Decorative metal %IT All brick(simulated or regular) kJ� 1�1 � Stucco banding Vu N Any other stucco features Ny Accessory Buildings Z Other, , N ************************************************************************************************************ 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 cons ction and zoning. signature � `2� - Datd� -- �-� Owner or Agent � 3 L hl, APPLICATION APPROVED BY: �. Date P&Z Official chc 6/18/03 cocturlo I