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PT-06-2962 Miami Shores Village � CE�� g DEC 0 7 2006 Building Department BY.A � 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 BUILDING 0111 0(oU;. Permit No. PT b6 2-q Q- PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type(circle): Building Electrical Plumbing Mechanical Roofing 4 _ q Owner's Name(Fe//e Simple Titleholder) Phone# ',3 O Owner's Address b ` � L�� -� City /j �./J �-. State L,© It.� (`,� Zip 3 3 1 (zg' C 4.1 /V Tenant'Lessee Name Phone# Job Address(where the work is being done) (� ( j ( L,2! 1 City Miami Shores Villaee County Miami-Dade Zip `3 T- FOLIO/PARCEL# Is Building Historically Designated YES NO Contractor's Company Name Phone# Contractor's Address City. State Zip Qualifier Name Phone# State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name(if applicable) Phone# W-- Value of Work For this Permit$ Square inear Footage Work: Type of Work: ❑Addition Alteration ❑New ❑ Repair/Replace ❑Demolition Describe Work: Submittal Fee$ Permit Fee$ 0. M CCF$ 1&0 CO/CC Notary$ Training/Education Fee$ Technology Fee$ Scanning$ Radon$ DPBR$ Zoning$ Bond$ Code Enforcement$ Double Fee$ Structural Review.$ Total Fee Now Dues-07- See Reverse side-+ A DEC 14 PAID 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 inspectigo,which occurs sev days after the building permit is issued In the absence of such posted notice, the inspection will not a roved and a r rnspectio fqe will be charged Signature /� Signature Owner or A ent Contractor The f ego' instrument was acknowledged before me this The foregoing instrument was acknowledged before me this dayPOr- ,20 i ,by Cr N14ay of 20_,by , who is personally known to me or who has producedM/4 20- who is personally known to me or who has produced (K-y As identification and who did take an oath , ++ 'as identification and who did take an oath. NOTARY PUBLIC: ,� 9g "' -NBTARYRtTBLIC: Sign: Sign: Print: 01t lt4 Print: My Commission Expires: My Commission Expires: APPLICATION APPROVED BY: Plans Examiner Engineer Zoning (Revised 02/08/06) Miami Shores Village Paint Color Approval and Agreement Date: Owner's Name: —Yhone#: O Job Address (where the work is being done): e�7 N Ui ( 09 ic p City: Miami Shores Village_County: Miami-Dade Zip: IS-5 / 6 Is Building Historically Designated?: YES NO Contractor's Company Name(if applicable): Phone#: All elements on the site must be listed and indicate the color to be painted Walls: Fascia: ` Attach color Samples with numbers Drip Cap/Drip Edge: Soffit: Roof: Flower Bins: Shutters: Awnings: 556 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• certify that all the foregoing information is accurate and that all work will be done in compliance wi all plicable laws r ing construction and zoning. Signature: Date: Owner or A ent APPLIC ION APPROVED BY:I �� ' Date: P&Z OFFICIAL "MUST BE ATTACHED WITH PURPLE BUILDING APPLICATION"