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PT06-1121 Miami Shores Village . Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 7E5_ 3 o ) . 2-7 Ar Tel:(305)795.2204 Fax:(305)756.8972 BUILDING Permit No.�� PERMIT APPLICATION M Y Q, L 205, Master Permit No. FBC 2004 1-3'f.____ -...•---- Permit Type (circle) Buildin ( Electric Plumbing Mechanical Roofing Owner's Name(Fee Simple Titleholder) 1 1 Owner's Address 21-7 city,`\44 State ` Zip 5 Tenant/Lessee Name Phone# Job Address(where the work is being done) City Miami Shores Villaize County . Miami-Dade Zip 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# Value of Work For this Permit$ Square/Linear Footage Of Work: Type of Work: !❑�Ad�dition ❑Alteration ❑New ,,❑ Repair/Replace El Demolition Describe Work: \CJ 1 1� _�V1t� �LA� 1!!�)yz /*�*-*�**�*��*****��***�*************�******�** Submittal Fee$ Permit Fee$ `:Jo CCF$ © .(00 CO/CC Notary$:�: M Training/Education Fee$ ®- j!�O Technology Fee$ 1. Scanning$ Radon$ DPBR$ Zoning$ Bond$ Code Enforcement$ Double Fee$ Structural Review.$ Total Fee Now Due$ V� See Reverse side Bonding Company's Name(if applicable) Bonding Company's Address 2j7z ue � 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 su o attachmen Also, a certified copy of the recorded notice of commencement must be posted at the job site for the firs nape ' n h ch dccu sev n (7) days after the building permit is issued. In the absence of such posted notice, the inspection wi 1 ppr ved an a ret spection fee will be charged. Ai ature Signature Ownerlaowledged gent Contractor The fore�going instrument was bbefore me this The foregoing instrument was acknowledged before me this A day of '_`A-A ,2(� Ib -/1 1 . )e* ,20 by , who is personally known to me or who has produced who is personally known to me or who has produced t As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: C,STATE op FLORIDA NOTARY PUBLIC: yode ny dez 6455 Sign: p, 27 9 Sign: ndin8 °• Print: Print: My Co mi Sion Expir My Commission Expires: ARAPPLICATION APPROVED BY: Plans Examiner // ( Engineer •4 Zoning (Revised 02/08/06) Miami Shores Village • Paint Color Approval and Agreement Date F�, r � �' Phone# Owner's Name S-- Owner's Address -�-77 Q!SA `�A 75 City" ` A State \ zip C' Job Address(where the work is being done) 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 Wal Fascia Drip Cap rip Edge Soffit Roof F Jes Flower bins Shutters Awnings 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 AFF VIT: I e at 1 the fore oing info tion is accurate and that all work will be done in compliance with all applicable laws regul n on d zoning Date S ignatur Owne or Agent APPLICATION APPROVED BY: Date . P& Official clic 6/18103 4. 1y,�OREs Miami Shores Village 'M 10050 N.E. 2nd Avenue ""' Miami Shores, FL 33138-0000 Phone: (305)795-2204 Fax: (305)756-8972 �LORtDp' Permit Permit Status: APPROVED Issue Date: 5/3/2006 Expires: 10/28/2006 Permit Number: PT-5-06-1121 Owner's Name: ROSE DESMORNES one: (305)300-8902 Permit Type: Paint Parcel#: 1131010331120 Work Classification: New Block: Lot: Job Address: 274 93 Street NW Section: PB: Miami Shores Village, FL 33138- Contractor(s) Phone Primary Contractor Total Square Feet: 0 HOME OWNER Yes Total Valuation: $ 35.00 Comments: Re uired Insi3ections PAINT SECURITY WINDOW BARS ONLY Final Additional Information Type of Work:Exterior Color:BLACK Additional Info: Classification:Residential In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above-named contractor to do the work stated. Fees Due Amount Invoice Number Amt Due Amt Paid CCF $0.60 PT-5-06-24663 Education Surcharge $0.20 Total: Notary Fee $5.00 Permit Fee $60.00 Technology Fee $1.50 MAY 0 8 PAID Total: $67.30 L -Z-( -7 Building Department File Copy NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS,STATE AGENCIES,OR FEDERAL AGENCIES. Applicant Signature