PT-06-2865 Miami Shores VillageD 1CC IC97m
Building Department Nov 2 s Zoos
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 g Y: -----------
Tel:(305)795.J204 Fax:(305)756.8972
BUILDING rVPermit No. �
PERMIT APPLICATION MSS Master Permit No.
FBC 2004 -�-
mz�a
Permit Type (circle<Building Electrical TT\\Plumbing Mechanical ¢ Roofing
Owner's Name(Fee Simple Titleholder / �--W Phone#--0 ^
Owner's Address 1 / 0 JJ
Cityt State ..__ Zip
Tenant/Lessee Name Phone#
Job Address(where the work is being done) L� /V /V lb l C
City Miami Shores Village County Miami-Dade Zip
FOLIO/PARCEL#
Is Building Historically Designated YES NO-X _
Contractor's Company Name W Phone#
Contractor's Address
City Zip
Qualifier Name Phone#
State Certificate or Registration No. a of Competency No.
Architect/Engineer's Name(if applicable) Phone#
Value of Work For this Permit$ Square/Linear Footage Of Work:
Type of Work: ❑A dition Alteration ew Repair/Replace Demolition
YP ❑ � ❑ ❑
Describe Work:
I
Submittal Fee$ Permit Fee$ l Q (`f J� CCF$ CO/CC
Notary$ _ Training/Education Fee Technology Fee$ A-)
Scanning$ Radon$ DPBR$ Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due$ -
o.
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.
tcSigna641 Signature
Owner or Agent Contractor
The fore ing instrument was ac owledged before me thisforegoing instrument was acknowledged before me this
day of ,by y of .20�by ,
who is person
known to me or who has produced lbtwi
o 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 P B C: ,SPpypU�
Man, '' �iOTARY PUBLIC:
:Commission:] ])231
-'.�:* Expires• 3,200
onded Thru
Sign. / fnF ppJ1tib o. Si
gn.
Print: Print:
My Commi sion Expires: My Commission Expires:
lZi
APPLICATION APPROVED BY: /Z ok Plans Examiner
V, Engineer
Zoning
(Revised 02/08/06)
k Miami Shores Village
Paint Color Approval and Agreement
Date: 10,6
',—Owner's Na Phone#:
Job Address( here the work is being done):/6
City: Miami Shores Village County: Miami-Dade zip��- �(
Is Building Historically Designated?: YES NO
Contractor's Company Name(if applicable): �l 7'1 Phone#:
All elements on the site must be listed and indicate the color to be minted
Walls:
Fascia:
Drip Cap/Drip Edge: 1
Soffit: 1
Roof: c (.S , ti
Flower Bins:
Shutters: � �}
Awnings:
�
Chimney: W \
Doors and Door Jams:
Garage Doors: '� v
Railings: ti
Fences: n
Decorative Metal:
All brick(simulated or regular):
Stucco Banding: )A
Any other Stucco Features: kl
Accessory Buildings: A
Other:
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be
done in compliance with all a plicable laws regulating construction and zoning.
Signature: Date:
Owner o gent
APPLICATION APPROVED BY: Date:
P&z OF CIAL
**MUST BE ATTACHED WITH PURPLE BUILDING APPLICATION**