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PT-06-3065 Miami Shores Village DEC 2 2 2006 (�� a Building Department `} By.--At-,----: 10050 N.E.2nd Avenue,Miami Shores,FloridaFld33138 ---_-____ Tel:(305)795.2204 Fax:(305)756.8972 1 BUILDING ���rof �' Permit No. PERMIT APPLICATION n Master Permit No. FBC 2004 Permit Type(circle)- Building Electrical Plumbing Mechanical Roofing v Owner's Name(Fee Si a Ti er) �/�� y� Plone# `l -� Owner's Address / ))I67e2 CityState f�- Zip 3 'Fl,S�c7 Tenant/Lessee Name Phone# Job Address(where the work is being done) )40 go S� _ City Miami Shores Village County Miami-Dade Zip FOLIO/PARCEL# Is Building Historically Designated YES NO Contractor's Company Name A4)my•2 0 Phone# Contractor's Address City State ip Qualifier Name :::Wkft=E1ne# 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: ew Addition Alteration ❑ Repair/RDemolition Describe Work: Submittal Fee$ Permit Fee$ CCF$—n-�2r_ CO/CC Notary$� Training/Education Fee$ ©' Technology Fee$ '-s Scanning$ Radon$ DPBR$ Zoning$ Bond$ Code Enforcement$ Double Fee$ Structural Review.$ Total Fee Now Due$.0- 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. Signature Signature Owner or Agent Contractor The fore oing instrument was acknowledged before me this-72— The foregoing instrument was acknowledged before me this day of� 20r,6 by day of .20 by Who is personally known to me or who has produced who is personally known to me or who has produced fmaL s identification and who did take an oath. as identification and who did take an oath. NOTARY UBLI YP Mabel Vargas NOTARY PUBLIC: Com • ' #DD2319 Ex u V , Sign: '.' Sign: ii 6: Print: Print: My Com 'ssion Expires: My Commission Expires: APPLICATION APPROVED BY: Plans Examiner Engineer C` t� (d Zoning (Revised 02/08/06) } ' Miami Shores village Paint Color Approval and Agreement Date Phone Owner's Name [� Owner's Address ��� /V / �^ State Zip Clty�, 4 j Job Address(where the work is being done) APR City Miami Shores Village County Miami-Dade Zip Is Building Historically Designated YES NO -- :- Contractor's Company Name(if applicable) ' PhoneQ� All elements on the site must be listed and indicate the color to be painted Walls Fascia Drip Cap/drip Edge Soffit Roof Seafoam Breeze Flower bins 90GG 73/062 NC21 Shutters Awnings In , Chimney Doors and door j ms 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 informa �isaccurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. / Date l� o Signature Owner or nt APPLICATION APPROVED BY: �` Date P&Z Official �h�6itsio3