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PT-06-1617 _ Miami Shores Village F,P-1C�TVED * + r Building Department artment JUN 14 2006 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: - Tel:(305)795.2204 Fax:(305)756.8972 BUILDING Permit No. ► \ 0 PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type(circle): ui mgectr'ca Plumbing Mechanical Roofing �Go ERv� 4 Owner's Name(Fee Simple o der) Phone# "J Dor —7K—[-3- Owner's Address 0 CityState Zip 3�� 1 —� � 7 Tenant/Lessee Namezz4i Phone# Job Address(where the work is being done) 41-rt� 0-4, �— city Miami Shores Village County Miami-Dade Zip FOLIO/PARCEL# Is Building Historically Designated YES NO_ >< Contractor's Company Name Phone# Contractor's Address CityState Zip Qualifier Name eS cco e o State Certificate.or Registration No. Al ncy No. Architect/Engineer's Name(if applicable) lV A Phone# / eoo7 1 Value of Work For this Permit$ f,S0 o Square/Linear Footage Of Work: 0 0 C%Lf:CG ?�J Type of Work: ❑ ddition ❑Alteration ew JA Repa' /Replace El Demolition tl, Descjribe Work: � ******Fees**** Submittal Submittal Fee$ 112r Permit Fee$ (n ��, CCF$ © � CO/CC Notary$ `S DL) Training/Education Fee$ - Technology Fee$ Scanning$ Radon$ DPBR$ Zoning$ Bond$ Code Enforcement$ Double Fee$ Structural Review.$ Total Fee Now Due$ G.-7 , �U See Reverse side Bonding Company's Name(if applicable) Bonding Company's Address ' • City State Zip Mortgage Lender's Name(if applicable) /q A 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 Signature c�L g Si afore Owner or Agent Contractor The foregoing instrument was acknowledged;.b�e-fdwe -The foregoing instrument was acknowledged before me this day of 20 a,by ,(/I(,►, �('(DY1 day of .20 by > who is �rsonall known to e or who has r P y produced �5� who is personally known to me or who has produced r r y As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC; ' DUZ Sign: EW `: MY COMMISSION:W Sign; Print: p z B.,w ThN Nary PUM UM"'"'s Print: My Commission Expires: My Commission Expires: APPLICATION APPROVED BY: Plans Examiner Engineer Ler Zoning (Revised 02/08/06) Miami Shores Village Paint Color Approval and Agreement Date j4_ _f10_b / Owner's Name G-7L Phone# S ?� 6 �-33 Owne,r-'s Address G City L z State ip 53/3 R fir;`7 A14-IVA Job Address(where the work is being done). ,JCY Lc � /Z4 _' City Miami Shores Village County Miami-Dade Zip Is Building Historically Designated YES NO Contractor's Company Name(if applicable) h1l At. Phone# All elenjents on the Re must be listed indicate tht. col to be painted Walls _ Fascia Drip Cap/drip Edge Soffit - Roof Flower bins Shutters Awnings '71 4- Chimney 6L.- Doors and door jams--j 2!" Yuma Peach 2175-60 Garage doors Railings 'h Fences Decorative metal All brick(simulated or regular) "Y! Stucco banding --y'1 Chantilly Lace 2121-70 Any other stucco features ­�1 Accessory Buildings Vt 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 0�4Date to W d Owner or Agent APPLICATION APPROVED BY: r� Date 1 s1�i� P&Z Official ckic 6/18/03 CANCULEL;