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PT-06-2721 Miami Shores Village MC M97m Building Department NOV 0 3 2006 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY .. .. ............. Tel:(305)795.2204 Fax:(305)756.8972 BUILDING Permit No. 1" 1 V(C7 27ZI PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type (circle): Building Electrical/ Plumbing Mechanical Roofing Owner's Name(Fee Simple Titleholder) /A'ZAM11eA �/�i�-'��af Phone# :?V s— /dam 9YP'3 Owner'sAddress & 7 A/W 10 0 �Ylt P,-4 City f/)9/A ft' �KO" State Zip 3&/50 Tenant/Lessee Name Phone# Job Address(where the work is being done) dVU /00 Wtpd City Miami Shores Village County Miami-Dade Zip 23 l S D FOLIO/PARCEL# Is Building Historically Designated YES NO Contractor's Company Name ©WJ tz, Phone# Contractor's Address CityState 4116 t LL t 11 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: ❑((Addd��itionn I ❑Alteration New ❑ Repair/Replace ❑Demolition Describe Work: Submittal Fee$ Permit Fee$ CCF$ V'�J� CO/CC Notary$' Training/Education Fee$ Q Technology Fee$ _ Scanning$ Radon$ DPBR$ Zoning$ Bond$ Code Enforcement$ Double Fee$ Structural Review.$ Total Fee Now Due$ See Reverse side Bonding Company's Name(if applicable) I Bonding Company's Address s 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 Och occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be roved and a reinspection fee will be charged. Signature Signature Owner or Agent °'` `;,.. Contractor The foregoing instrument was ac is The foregoing instrument was acknowledged before me this day of H OU ,20()&by day of .20_,by who is personally known to me or who has produceA 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 U LIC: NOTARY PUBLIC: iVlabelVargas ommission#0231984 Sign: - *= 11il 13,2007 Sign: Print: ," � BmdedThru Atlmtie Bonding Co. Inc print: My Comm ssion Expir My Commission Expires: APPLICATION APPROVED BY: ! Plans Examiner Engineer Zoning (Revised 02/08/06) Miami Shores Village Paint Color Approval and Agreement Date: ®I3/0(- AX. / ,�Gv Owner's Name: ZAf (k,4y le X-- Phone#: - �ld�-9 K,; � Job Address (where the work is being done): w /O C9 e-.t City: Miami Shores Village County: Miami-Dade zip: Is Building Historically Designated?: YES NO Z--- Contractor's Company Name(if applicable): Phone#: All elements on the site must be listed and indicate the color to be minted Walls: I TPC pec-� 0 Fascia: 2 Attach color Samples Drip Cap/Drip Edge: (,iJYll with numbers Soffit: 1jV11 u Roof: Flower Bins: Shutters: Awnings: Chimney: (� Doors and Door Jams: Garage Doors: 11aA Railings: Fences: Decorative Metal: All brick(simulated or regular): Stucco Banding: Any other Stucco Features: Accessory Buildings: Other: OWNER'S AFFIDAVI . I certify that all the foregoing information is accurate and that all work will be done in compliance vA9 all applicable laws regulating construction and zoning. Signature: Date:At-lt Owner or Agent , APPLICATION APPROVED BY: Date: P&2 OFFICIAL "MUST BE ATTACHED WITH PURPLE BUILDING APPLICATION"