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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"