PT06-1523 �.
0sloo
am.Q,� Miami Shores Village
y
ry,,-) Building
u lding Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
®m Tel:(305)795.2204 Fax:(305)756.8972
BUILDING Q M C MICT Permit No. �D(o- —'z-
PERMIT APPLICATION Y'calPlu
006 aster Permit No.
FBC 2004
BPermit Type(circleBuilding Electmbing Mechanical Roofing
Owner's Name(Fee Si le Titlehol WAV-Y.&l Aaa 9Rinl 1%ZKOL Phone# 3057-757-95ry4
Owner's Address 131 N rJ //o 57a£o-'
City_141*,Vtt SKo(L05 State Fi- Zip 33/66
Tenant/Lessee Name N)A Phone# t 1 lA
Job Address(where the work is being done) SAN1 ig-
City Miami Shores Villase CouAtj Miami-Dade Zip
FOLIO/PARCEL#
Is Building Historically Designated YES NO X
Contractor's Company Name tj/A, 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) ,.�A Phone#
Value of Work For this Permit$ igml Square/Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration ❑New ❑ Repair/Replace ❑Demolition
Describe Work:
Submittal Fee$ Permit Fee$ CCF$ O-� CO/CC
Notary$ Training/Education Fee$ Technology Fee$ d-'-
Scanning$ Radon$ DPBR$ Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due$ U
See Reverse side—�
Bonding Company's Name(if applicable) ,—
Bonding Company's Address r ,
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 no be approved and a reinspection fee will be charged.
Signature Signature
Owner or Agent Contractor
The foregoinginstrumentwas acknowledged before m is S The foregoing instrument was acknowledged before me this
�J
day of —k-1C,2d b L r�4!T-day of .20_,by
who is personally known to me or who has produced who is personally known to me or who has produced
l� As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
1)fi C.6 PLO A
eT ellez
Sign:_PrLNAW 5 Sign:
Print: k�l r nr tnc. Print:
My Commissio Expires: My Commission Expires:
APPLICATION APPROVED BY: Plans Examiner
Engineer
cp �� y� Zoning
(Revised 02/08/06)
CRES Miami Shores Village
al 10050 N.E. 2nd Avenue
"" Reveal"
" Miami Shores, FL 33138-0000
Phone: (305)795-2204 Fax: (305)756-8972
�LOR1Dp'
Permit
Permit Status: APPROVED
Issue Date: 6/9/2006 Expires: 12/02/2006 Permit Number: PT-6-06-1523
Owner's Name: WARREN & ERIN PARKER one: 305-757-9549
Permit Type: Paint
Parcel M. 1121360030540
Work Classification: New
Block: Lot:
Job Address: 131 110 Street NW Section: PB:
Miami Shores Village, FL 33168-
Contractor(s) Phone Primary Contractor Total Square Feet: 0
HOME OWNER Yes Total Valuation: $ 500.00
Comments: Re uired Inspections
EXTERIOR PAINTING
Final
Additional Information
Type of Work:Exterior Color:SW2850,SW2864,SW2849
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-6-06-25070 $67.30
Education Surcharge $0.20 Total:
Notary Fee $5.00
Permit Fee $60.00 SUN 12 PAID
Technology Fee $1.50 �\
Total: $67.30
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
r Miami Shores Village
10050 Northeast Second Avenue
Miami Shores,Florida 33138-2382
Telephone:(305)795-2207
Fax:(305)756-8972
www.miamishoresvillage.com
Paint Color Approval and Agreement
DATE: 6-6-0(0
OWNER'S NAME: WAS IL0 4, SRiPJ PHONE: 3oS,757.Qrsyq
ADDRESS: t3% Nva 00 STRBET
ADDRESS OF SITE: %S% AVO 1%0 s-r%EUT
CONTRACTOR&LICENSE(if applicable) N!A . owivrrL
COMPANY NAME: N A PHONE: N 1/�+
All Elements on the site must be listed and indicate the color to be painted.
Walls: 5W 2850
Fascia: r )A
Drip Cap/Drip Edge: cw Z190i
Soffit: 5W 2Y411
Roof: UMAW S W V01 E
Flower Bins: N I A . Sol` Sw ZSSo
Shutters: MIA
Awnings:
Chimney: 5� 27401 SW Z2(-I'
Doors and door jams: sW ZU14
Garage Doors: N 1A
Railings: NIA
Fences: t4 1 ASw2�Kq
Decorative Metal: q A
All brick (simulated or regular): JA
Stucco Banding: ori cviimsp4 - 5W 2SrG1i
Any other stucco features:
Accessory/Buildings: N JA _
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. 1 authorize the above-named contractor, if applicable, to do the
work stated. Furthermore, the paint colors will be as per the attached samples.
6-G-oGIV JA
Signature of Owner Date Signature of Contractor Date
APPROVED:
WHEN PAINTING IS FINISHED, CALL FOR FINAL
-( ' INSPECTION