PT-06-2567 RFs Miami Shores Village
�� 10050 N.E. 2nd Avenue
"" ""' Miami Shores, FL 33138-0000
moo.* Phone: (305)795-2204 Fax: (305)756-8972
OR1Dp`
Permit
Permit Status: APPROVED
Issue Date: 10/16/2006 Expires: 04/14/2007 Permit Number: PT-10-06-2567
Owner's Name: CHRISTIAN LUBIN one:
Permit Type: Paint
Parcel#: 1131010220100
Work Classification: New
Block: Lot:
Job Address: 140 102 Street NW Section: PB:
Miami Shores Village, FL 33138-
Contractor(s) Phone Primary Contractor Total Square Feet: 0
HOME OWNER Yes Total Valuation: $ 1,000.00
Re uired Inspections
Additional Information Final
Type of Work:Exterior Color:
Additional Info: Classification:Residential
In consideration of the issuance to me of this permit, I agree to pe
rf
covered hereunder in compliance with all ordinances and regulatio CELLED
thereto and in strict conformity with the plans, drawings, statements or cifications
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-10-06-26413 $67.30
Education Surcharge $0.20 Total: �` �( �
It
Notary Fee $5.00
Permit Fee $60.00 OCT 16 PAID
Technology Fee $1.50
Total: $67.30 ] I
Building Department File Copy NOTICE: In addition to the requirements of this permit, there may be
additional restrictions applicable to this property that may be found in the
public records of this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
n DISTRICTS,STATE AGENCIES,OR FEDERAL AGENCIES.
Applicant Signature
Miami Shores Village p ��
Building Department Oct 13 06 U
• 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 IIll 11
Tel:(305)795.2204 Fax:(305)756.8972
BUILDING 116 Permit No.
PERMIT APPLICATION �r QOh,;� Master Permit No.
FBC 2004
Permit Type (circle): Buildin Electrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder) ja�r (A. Ljb i`� Phone# / 16 Z-61' W�`S
Owner's Address �L\O A l 02
City �C?M. S`n0i e S State Zip J cj (D
Tenant/Lessee Name Phone#
Job Address(where the work is being done) 1 LA C�) f )W
City Miami Shores Villase County Miami-Dade Zip 3 ti "S Q
FOLIO/PARCEL# — — 3 \ k--)0
Is Building Historically Designated YES NO
Contractor's Company Name Phone#
Contractor's Address
City State Zip
Qualifier Name Phone#
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name(if applicable) Phone#
Value of Work For this Permit$ Square/Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration New ❑ Repair/Replace ❑Demolition
Describe Work: RqI y--)4
es
Submittal Fee$ Permit Fee$ D �j—es CCF$ CSO,//CSC
Notary$_-_ Training/Education Fee$ Technology Fee$ I• o
Scanning$ Radon$ DPBR$ Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due$
See Reverse side-OCT 6 D�
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.
—� Si afore
Signature y�i1.t..P e,�(1��, �n.�1� A,. XN�,� �
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of��,20(Xby 00 !, 0u YA l 1 V Ly i1AY of ,20_,by
who is personally known to me or who has produced * who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY C: 1V'I� , • NOTARY PUBLIC:
PUB
Sign: Sign:
Print: I Print:
My Commis ion Expires: My Commission Expires:
APPLICATION APPROVED BY: Lv �� Plans Examiner
Engineer
3 ' Zoning
(Revised 02/08/06)
Miami Shores Village
Paint Color Approval and Agreement
Date: t Z 0` 1
Owner's Name: na, �Q Phone#:
Job Address(where the work is being done): \LAO PJ (,J \0`L-
City:
0`LCity: Miami Shores Village County: Miami-Dade Zip: 3 c
Is Building Historically Designated?: YES NO
Contractor's Company Name(if applicable): Jai / C-�- Phone#: IBJ/ i
■.............................................../...............0 M a 0 0 0 0 a a N M a a 1
All elements on the site must be listed and indicate the color to be minted
Walls: ! )0, ( Q`)CcIn C —3
Fascia:
Drip Cap/Drip Edge:
Soffit:
Roof.-
Flower
oof:Flower Bins: 31OC-3 P
Shutters: �,.1Warm Cocoon R
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 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.
Signature: Date:
Owner or Agent
APPLICATION APPROVED BY: j Date:
P&Z OFFICIAL
**MUST BE ATTACHED WITH PURPLE BUILDING APPLICATION**