PT-06-69 (2) Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
BUILDING T E C��v'� Permit No. �,r"GG " lD
PERMIT APPLICATION JA 21."6 Master Permit No.
FBC 2001 ---- - -------
Permit Type(circle): Building Flect (all Plumbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder) k! 2 Gtr Phone# =J ,3C
Owner's Address
Cit� Jj_� State Zip r7(0
Tenant/Lessee Name Phone# ----
Job Address(where the work is being done) �3 l V A/
City Miami Shores Village County Miami-Dade Zip A 3
Is Building Historically Designated YES NO ✓
Contractor's Company Name Phone#
Contractor's Address
City State p
Qualifier
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name(if applicable) Phone#
413M• 00
$Value of Work For this Permit Square Footage Of Work:
Type of Work: DAddition []Alteration []New ARe air/Re lace
/ p p ❑Demolition
Describe Work: PLt
Submittal Fee$ Permit Fee$ �V CCF S CO/CC.
Notary$. S - 00 Training/Education Fee$-- 0 . 40 Technology Fee$_1- (50
Scanning$ Radon$ Zoning Bond$
Code Enforcement$ Structural Plan Review.$
Total Fee Now Due$ 67 3d
(Continued on opposite side)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State ^ .
Zip
J
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 reinspectionfie be charged
Signature Signature
Owner or yAge Contractor
The foregoing instrument was acedged before me this CA The foregoing instrument was acknowledged before me this
day oQLA 20C*by 21=- n
M y Mow tow (o(Qay of ,20___,by ,
who is personally known to me or who has produced who is personally known to me or who has produced
.D As identificotion and who did take an oath. as identification and who did take an oath.
NOTAR BLIC• pow,,P IC OF PL0 NOTARY PUBLIC:
Sign:
Sign:
Print: s Print:
My C m' sion Expires`:—` T Atlantic Bonding Co.,inc,' ..My Commission Expires:
APPLICATION APPROVED BY: j 0 Plans Examiner
Engineer
P
chc 05/13/03 Zoning
Miami Shores Village
Paint Color Approval and Agreement
Date
l Phone#
Owner's Namel�h(.< '
Owt 's Address
City
State Z1P
Job Address(where the work is being done) / L✓ ^-3
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 painted
Walls
Fascia
Drip Cap/drip Edge
Soffit
Roof
Flower bins
Shutters — F I
Awnings 260E-3 "
Chimney Pueblo Sand
Doors and door iams 11
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.
Date
Signature
Owner or Age t
Date
APPLICATION APPROVED BY: P&Z Official chc 6/18/03
CANCELLED