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PT-06-1848 . . -, C�,�l�c� 1��. 4YTv�ro Miami. Shores Village r-,'.06 Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax: (305)756.8972 BUILDING ;RECEIVED Permit No.ao (o-'s4s& PERMIT APPLICATIO L 1 0 2006 Master Permit No. FBC 2004 IBI.1 OAN Permit Type(circle): Building Electrical Plumbing Mechanical Roofing Owner's Name(Fee Simple o der)�'v Phone# Owner's Address S - City U IA M� State . Zip a Tenant/Lessee Name Phone# Job Address(where the work is being done) `T Q�Vyj City Miami Shores Villa e County Miami-Dade Zip FOLIO/PARCEL# Is Building Historically Designated YES Contractor's 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$ `�� 0 Square/Linear Footage Of Work: Type of Work: ❑Addition ❑Alteration ew ❑ Repair/Replace ❑Demolition Describe Work: tip LUY� 4cio, L Submittal Fee$ Permit Fee$�4 Q CCF$ CO/CC Notary$ Training/Education Fee$ Technology Fee$ Scanning$ Radon$ DPBR$ Zoning$ Bond$ Code Enforcement$ Double Fee$ Structural Review.$ Total Fee Now Due$ f n V See Reverse s JUL 1 r4 7 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 ith that a co o the notice o commencement and construction lien law brochure will be delivered to the person promise in goodfaith y f f P g .f P :. whose property is subject to attachment. Also, a certified copy 6116e 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 L115b Signature Owner or Agent Contractor The for Ning instrument was a knowledged before me this The foregoing instrument was acknowledged before me this day of ,20 v,by 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: OF VL01"TARY PUBLIC: �OBUC-STATE Caceres Lidia Sign: issionA DD53 Print: _ (/� Expues. .c,,ndr841thnt My Commiss;on Expires: j—/ -Z��1}on4� My Commission Expires: APPLICATION APPROVED BY: Y Plans Examiner Engineer \V Zoning (Revised 02/08/06) Miami Shores Village Paint Color Approval and Agreement Date C; n �RJ�'� G (' Phone# Owner's Name �tatcl Owner's AddressCity � ,T� ZiP !� Job Address(where the work is being done) �- city Miami Shores Village County N iam-i-Dade Zip Is Building Historically Designated YES NO Contractor's Company Name(if applicable) �ti� Phone# C All elements on the site must be listed and indicate the color to be painted Walls >L al �pp S 1L �� Fascia �SL..9_) b © C-- Drip Cap/drip Edge i.t (Zd)0C — Soffit Roof Flower bins Shutters y� Awnings Chimney Doors and door jams Garage doors ca oo� Railings Fences CA_ C n® tf, Decorative metal All brick(simulated or r lar Stucco banding Any other stucco features ' j or' Accessory Buildings Other. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done incompliance with all applicable laws regulating construction and zoning. Signature_ ��'o"" `�_ Date 1 6� Owner or Agent APPLICATION APPROVED BY: Date P&Z Official dic 6/18/03 �CEIIED CA