PT-06-2617 Miami Shores Village
g �
Building Department OCT 2 0 2006 L
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 6 Y.
Tel:(305)795.2204 Fax:(305)756.8972
BUILDING 1017woG Permit No. (� 06" zip
PERMIT APPLICATION JIMM, tkZ- Master Permit No.
FBC 2004
Permit Type(circle): Building Electrical Plumbiinng/�� Mechanical Roofing
Owner's Name(Fee Simple Titleholder) hone# ..XJ — 75GG16C7�
Owner's Addr ss
City r State/ Zip313�
Tenant/Lessee Name Phone#
Job Address(where the work is being done) LQ
City Miami Shores Villas County Miami-Dade Zip
�.3
FOLIO/PARCEL# � 2 a� 0/ — 16,Q9
Is Building Historically Designated YES NO_ ,
Contractor's Company Name (i(>nail a N ej Phone#
Contractor's Address
6AP1111 IPD-
Ci 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$ Square/Linear Footage Of Work:
Type of Work: Addition ElAlteration E]New Repair/Replace
El Demolition
Describe Work:
I
��r**************�*******
Submittal Fee$ Permit Fee$ r CCF$/ CO/CC
Notary$ �'� Training/Education Fee$ o-5n Technology Fee$ -
Scanning$ Radon$ DPBR$ Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due$
See Reverse side-+
0 <3$34
OCT 2 5 20
Bonding Company's Name(if applicable)
Bonding Company's Address c
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 properubattachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the fih occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspectioed and a r pectionfee will be charged.Signature 3Sior Agent Contractor
The foregas acknowledged before me this The foregoing instrument was acknowledged before me this
day of ,20_,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: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
My Commission Expires: My Commission Expires:
APPLICATION APPROVED BY: 6/y2 Plans Examiner
Engineer
Zoning
(Revised 02/08/06)
Miami Shores Village
Paint Color Approval and Agreement
Date: O 6
Owner's Name: Rhone#: 36��— �56 1668
Job Address(where the work is being done):
City: Miami Shores Village County: Miami-Dade Zip: �33 l3V
Is Building Historically Designated?: YES NO
Contractor's Company Name(if applicable): ou 21 Vc Phone#:
.....U 0 M N M E N E 0 a a 0 0 0 a 0 0 N 0 E M a M 0 E 0 0 0 0 0 N a E E N 0 0 M 0 a a 0 M 0 a 0 E 0................\0 0 0 0 0\0 1
All elements on the site must be listed and indicate the color to be Minted
Walls:- kRe, � U— , _-
Fascia: 1041 � � Attach color Samples
Drip Cap/Drip Edge: (, k 0�c lF(j! InteriorSoffit: C(W/N � �
/ , IGI��L �'C�h:f - ter►——T
Roof. •
Flower Bins: V14 Seml"(
Shutters: P U11 66F On( dK bacf)
Awnings: PIA Enamel
Chimney: d
Doors and Door Jams: ' "
Garage Doors: -•- Y�
Railings: IWQ `
Fences:
Decorative Metal: N�
All brick(simulated or regular): /�l
Stucco Banding: /(/�� HM 1424 WHITE
/44ONE GALLON (3.185 Q
Any other Stucco Features:
Accessory Buildings: /y
Other: (2i
..............0000..... ■0■ ■000000000000000000■..............................�
OWNER'S AFFID VIT: certify t at a e fo going information is accurate and that all work will be
done in complianc th icab ing construction and zoning.
Signature: Date:
:ED
er or
APPLICATION APP BY: % Date:
P&Z OFIFICIAL
"MUST BE ATTACHED WITH PURPLE BUILDING APPLICATION"