PT-06-3006 a
Miami Shores Village X
l
Building Department DEC 4 1006
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
BUILDING jug Permit No. IPTD(D — �OO(O
PERMIT APPLICATION Master Permit No.
FBC 2004
Permit Type (circle): Buildin Electrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder) . -5*�OJ/C-�Phone# M7 6`1 r :3
Owner's Address
City &4 / State JE -- Zip 72 7?z 0
Tenant/Lessee Name Phone#
Job Address(where the work is being done) 'Of-�
City Miami Shores Villaize County Miami-Dade Zip
FOLIO/PARCEL#
Is Building Historically Designated YES NO�_
Contractor's Company Namer*Amww1 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#
Value of Work For this Permit$ -j 0 Square/Linear Footage Of Work:
Type of Work: []Addition ❑Alteration ❑New ❑ Repair/Replace
El
Describe Work: 'y'� e Y-- &f2�
Submittal Fee$ Permit Fee$ O • k_)� CCF$ ' (00 C CO/CC
Notary$ S— Training/Education Fee$ i 2 V Technology Fee$ r -S U
Scanning$ Radon$ DPBR$ Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due$
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 ccurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection w' of be approved d a reinspectio fee will be charged.
Signature Signature
O er ot1powledged
gent Contractor
The foregoing ins en^^t rrw--as a �^ oobennfore me this I, The foregoing instrum was acknowledged before me this
day of Q�20�by �G�,�X � "Wday of ,20 by
who is personally known to me or who has produced who is personally known to me or o has produced
As identification and who did take an oath. as identification an ho did take an oath.
NOTARY UBLIC 1vIaI1e1 d,air gas
4 NOTARY PUBLIC:
Co_Co 'res- 13,207
Sign: s;., :oa and
Sign:
Print: Print:
My Co ission Expires: My Commission Expires:
"*,j
APPLICATION APPROVED BY: 02-0 7-0 7 Plans Examiner
Engineer
o Zoning
(Revised 02/08/06)
Miami Shores Village
Paint Color Approval and Agreement
Date: / C 1 -7
Owner's Name: C � �
�i�� U.U'�L i�- ,�� 1 Phone#:
Job Address(where the work is being done): Ar
City; Miami Shores Village County: Miami-Dade Zip:
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 minted
Walls:.-I/ 1 �1 G Gt Lo
Fascia: ✓ ,� � Attach color Samples
Drip Cap/Drip Edge:
with numbers
Soffit:
Roof:
Flower Bins:
Shutters:
Awnings:
Chimney:_
Doors and Door Jarrls: ,
Garage Doors:
Railings: SW 6316
Rosy Outlook
Fences:
Decorative Metal:
All brick(simulated or regular): d`
Stucco Banding: Al ��--
Any other Stucco Features: 4/4
Accessory Buildings: A% -
Other:
OWNER'S AFFIDAVIT: I certify that 11 the foregoing information is accurate and that all work will be
done in compli 7,�1,1,a pplica 1 a s regulatin construction and zoning.
Signature: Date: �'`
n or Agent
r
APPLICATION APPROVED BY: Date:
P&Z OFFICIAL
"MUST BE ATTACHED WITH PURPLE BUILDING APPLICATION"