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PT-06-1950 Miami Shores Village Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 BUILDING �C ���� Permit No. PERMIT APPLICATION jUL 2 0 2006 Master Permit No. FBC 2004 B Y:t�,-------- Permit Type(circle): in Electrical Plumbing Mechanical Roofing Owner's Mame(Fee Simple Titleholder) AAV(Z/& / Phone# Owner's Address 7 3 6 AQ&e .5 CitYw► i �� d .j State %L zip Tenant/Lessee Name Phone# Job Address(where the work is being done) / 7.3 /y-P zQ(p V City Miami Shores Village County Miami-Dade Zip FOLIO/PARCEL# Is Building Historically Designated YES NO__4_ Contractor's Company Name Phone# Contractor's Address CityState Zip Qualifier Name State Certificate or Registration No. V Certs cy No. Architect/Engineer's.Name(if applicable) Phone# Value of Work For this Permit$1CO(I dp Square/Linear Footage Of Work: Type of Work: ❑Addition ❑Alteration New ❑ Repair/Replace ❑Demolition Describe Work: Submittal Fee$ Permit Fee S_ -CC) CCF$ o GO - CO/CC Notary$S-(:: Training/Education Fee$ Technology Fee$ (.SO Scanning$ Radon$ DPBR$ Zoning$ Bona$ Code Enforcement$ Double Fee$ Structural Review.$ Total Fee Now Due$ See Reverse side-+ 1 l G Q 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 toning. "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 Signature wner or Agent nnom�,, Contractor The foregoing instrument was ac owleydg� before me this Ck� The foregoing instrument was acknowledged before me this day of20croby 1 11VW3 da}yiif .20 by , who is personally known to me or who has producl 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 BIC: NOTARY PUBLIC: �vlal)ej Commisst`on# -� • � Ires_1 DD231�� Sign: Sign: Print: , Print: My Com ' sion Expires: My Commission Expires: APPLICATION APPROVED BY: d Plans Examiner Engineer Zoning (Revised 02/08106) Miami Shores Village Paint Color Approval and Agreement Date 7hdto� / / Owner's Name /��Y°u�6i 8irre Phone# 06 -(O61)Z-2 Owner's Address1.7 3_N f- City�iGw1 i �0pe Slate 1__1LZip J�-5,11� Job Address(where the work is being done) 17 t4f- O,� �d- City Miami Shores Village County Miami-Dade Zip 35 13S7 Is Building Historically Designated YES NO D� Contractor's Company Name(if applicable) Phone# All elements on the site must be listed and indicate the color to be painted Walls Fascia Drip Cap/ ip Edge �A � Soffit 3 Roof Flower bins tach Color Samples Shutters With Numbers 3 Awnings I '. Chimney Doors and door jams Garage doors J Railings Fences Decorative metal tt `` All brick(simulated or regular) N Stucco banding Any other stucco features I Accessory Buildings ` 1 Body:Arbor Hollow ECC-37-1 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 Date O771@: APPLICATION APPROVED BY: Date al clic 6/18/03 \J 1 2 LJ � ✓SHIT$ , � o � i e a CANCELLED