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PT-06-2228 Miami Shores Village Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fag:(305)756.8972 BUILDING ��TI' Permit No.?T 6^ Z� PERMIT � C RMT APPLICATIO AUG 31 2006 Master Permit No. FBC 2004 Permit Type(circle): Building / ctrical Plumbing Mechanical Roofing Owner's Name(Fee Simple Titleholder) _ U 6 J Phone# -��� — Eq_(b ` Own 's Address J V City ` State Zip �5 Tenant/Lessee Name Phone# Job Address(where the work is being done) 3� i¢—�� C��A—4-j City Miami Shores Villase County Miami-Dade Zip ( �� FOLIO/PARCEL# Is Building Historically Designated YES NO Contractor's Company Name W 161 T Phone# Contractor's Address City. State Zip Qualifier Name ' Ll Phone# State Certificate or Registration No. hil U in Certcate of Competency No. Architect/Engineer's Name(if applicable) Phone# Value of Work For this Permit$ �� Square/Linear Footage Of Work- Type 1; Type of Work: ddition ❑Alteration New ❑ Repair/Replace ❑Demolition Describe Work: J �-j ►� (c� ,� Submittal Fee$ Permit Fee$ $ CO/CC Notary$ Training/Education Fee$ .J****,�****�Technology Fee$ Scanning$ Radon$ DPBR$ Zoning$ Bona$ Code Enforcement$ Double Fee$ Structural Review.$ Total Fee Now Due$ See Reverse side-� Bonding Company's Name(if applicable) Bonding Company's Address i 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 of er the building permit is issued In the absence of such posted notice, the inspection will not be approv and a reinspection fee will be charged Signature Signature O er or Agent Contractor l t The for oing ins t was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20�,by day of ,20_,by , who is peigonally 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 PUB IC: NOTARY PUBLIC: Sign: Sign: Print: IC N.COHENAft Print: My Commission u! a !!an0 My Commission Expires: Come 3H00'N 0Ikl3 APPLICATION APPROVED BY: Plans Examiner Engineer Zoning (R"ised 02/0s106) . , Miami Shores Village Paint Color Approval and Agreement Date Phone#----'(��i� Owner's Name Owner's Address r 33 City State Zip `3 3 � Job Address(where the work is being done) �-f �� o` 63E/ y 1 City Miami Shores Village County Miami-Dade Zip g1�0 Is Building Historically Designated YES NO_�_ Contractor's Company Na1ne (if applicable) Phone# All elements on the site must be listed and indicate the color to be painted Walls C-4TP-fir 1-5 H Fascia —Ml CADe� -� St� to25F5 Drip Cap/drip Edge /U Soffit ::-R], Roof E�`t 4#q' Flower bins �A Shutters SW 7006 Extra White Awnings n Chimney U '`� /► Doors and door jams Garage doors Railings 1 Fences Decorative metal All brick(simulated or regular) Stucco banding Any other stucco features Accessory Buildings 11V 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. Date Signature Owner or Agent 3 APPLICATION APPROVED BY: <% Date Ute P&Z Official oho 6118iO3