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PT-06-2779 Miami Shores Village D ����VM p BuildingDepartment Nov 14 2006 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 g Tel:(305)795.2204 Fax:(305)756.8972 BUILDING D M" Permit No. (DG _ PERMIT APPLICATION 0110M Master Permit No. FBC 2004 Permit Type (circle): Building Electrical Ylumbing Mechanical Roofing Owner's Name(Fee Simple it eholder) �c„�, i — Phone# Owner's Address '14-C) t Cl��. s T, City ry. or�� S t*oQ.CS State 7-L' Zip 31 Tenant/Lessee Name M I q Phone# Job Address(where the work is being done) 3 N C• R`k-'-,A 3* e City Miami Shores Village County Miami-Dade Zip FOLIO/PARCEL# Is Building Historically Designated YES NO Contractor's Company Name tN-,,4 t``Phone# Contractor's Address �- City State Zip Qualifier Name �� Phone# State Certificate or Registration No. �— p, �C-omm enc, � 1 Y • %0MULLUM Architect/Engineer's Name(if applicable) Phone# aJ �1 Value of Work For this Permit$ ���" Square/Linear Footage Of Work: Type of Work: ❑Addition ❑Alteration ew ❑ Repair/Replace ❑Demolition Describe Work: �f�t~hl'� O T�1^ /0 l�1 - Submittal Fee$ Permit Fee$ .6J • CCF$ COO/CC Notary$ Training/Education Fee$ •ZU Technology Fee$ Scanning$ Radon$ DPBR$ Zoning$ Bond$ Code Enforcement$ Double Fee$ ^^ Structural Review.$ Total Fee Now Due$ //�J7•8 . See Reverse side—� 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 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 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. Signa Sign Owner or Ag t Contractor The foregoing instrument 11ged before a this The foregoing instrument acknowledged before me this day of DC�Kho�by IJIJ m day of ,20 who is personally known to me or who has produced who is personally known to me or who produced As identification and who did take an oath. as identification and wh 'd take an oath. NOTARY P IC: NOTARY PUBLIC: Mabel Val-gas Si �on►mission 4; 023198,1 Sign: Sign: 9T. u Print: F;d Bad g'200 7 Print: BoAdirwCo..17 My Co i ion Ex 'res: My Commission Expires: APPLICATION APPROVED BY: �/ `J Plans Examiner Engineer Zoning (Revised 02/08/06) + Miami Shores Village Paint Color Approval and Agreement Date: tti Owner's Name: aPhone#: Job Address(where the work is being done): City: Miami Shores Villaee County: Miami-Dade Zip: Is Building Historically Designated?: YES NO Contractor's Company Name(if applicable): -1 (a Phone#: -q ...............................................■.............................■1 All elements on the site must be listed and indicate the color to be pwinted Walls: Fascia: Attach color Samples Drip Cap/Drip Edge: with numbers Soffit: Roof: 1.-� �F 1 i� � S Az- Flower zFlower Bins: r J� Shutters: Awnings: Chimney: Doors and Door Jams: Garage Doors: Railings: Fences: Decorative Metal: All brick(simulated or regular): Stucco Banding: Any other Stucco Features: Accessory Buildings: 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. Signa Date: 1t 1 Own or Agent n APPLICATION APPROVED BY: Date: P&1z bFFICIAL "MUST BE ATTACHED WITH PURPLE BUILDING APPLICATION"