PT-06-781 Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
BUILDING _ ,OV ® Permit NoF T 0L
PERMIT APPLICATI OAR 2 2A05 Master Permit No.
FBC 2001
Permit Type(circl Building El ctrica lumbing Mechanical Roofing
Owner's Name(Fee Simp a itl Mer I.
1, Phone#
Owner's Address Qk9y ,l/.6 .e"4
City &UQ 4; �5State fes'► Zip 130
Tenant/Lessee Name Phone#
Job Address(where the work is being done)
City Miami Shores Villaee County Miami-Dade Zip 35136
Is Building Historically Designated YES NO
Contractor's Company Name V l5GvJth( �Qrtr�1 tt.1(o Phone# 301 75/-?/6
Contractor's Address � � � amsc
City i _ State Zip_ 3308
8— --
Qualifier 11lad
State Certificate or Registration No. CWeftjjf%yNo. 9&,55002/Y'
Architect/Engineer's Name(if applicable) Phone#
$Value of Work For this Permit_T�jf�j.�-" Square Footage Of Work:
Type of Work: ❑Addition ❑Alteration ❑New ❑ Repair/Replace
❑Demolition
Describe Work: I c:e,
^
Submittal Fee$ Permit Fee$ . 00 CCF$ ' CO/CC.
Notary$ 15>• L3D Training/Education Fee$ n C� Technology Fee$
Scanning$ Radon$ Zoning Bond$
Code Enforcement$ Structural Plan Review.$
Total Fee Now Due$ �" Z-7 -0-9
(Continued on opposite side)
MAR 2 8 PAID
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.
( x
)Signature Signature
_�Q�
Owner or Agent Contractor
C •-
The forego' iidentification
was ack010176
wledged before me thi The fib ego' g instrument w�ass acknowledged before me this 2
day of by day of 2000 by V
who is ersonally kno me or who has produced who is personally known to me or who has produced
and who did take an oath. L- �l as identificat' and who did take an oath.
NOTARY P NOTARY P I N PUBLIC-STME OF n�l ".
Sign: Si rlen y a deG
r
J
Print: Print: EP. , 20S9
NOTARY P '
My Commission Expires: Dilcila Hernandez My issio
***** ***************** , Xpires: l
Bonded Thru Atlantic Bonding Co.,Inc.
APPLICATION APPROVED BY: 3 Plans Examiner
Engineer
Chc 05/13/03 Zoning
Miami Shores Village
Aw Paint Color Approval and Agreement
Date-3-4-3--.0-40—
Owner's Name o 1 (r Phone# ,�D�'�S7 73co
Owner's Address �J`"
- State f'[ Zip �3l�Jg
City —
Job Address(where the work is being done)
City Miami Shores Village County Miami-Dade Zip 33138
Is Building Historically Designated YES NO
--- --- Phone#
Contractor's Company Name Cif applicable) 15v 'T171 b�
All elements on the site must be listed and indicate the color to be painted
Walls Q7
Fascia
Drip Cap/driLdge�
Soffit
Roof
Attach Color Samples
Flower bins
Shutters Ldv✓ W1E� With Numbers
Awnings
Chimney O7
Doors and door jams — UJ
Garage doors
Railings
Fences
Decorative metal
All brick(simulated or regular)
Stucco banding
t,�tkt �
Any other stucco features ltlx`.� � Od� ��r� -
Accessory Buildings
Other P 1 �/`T"JA1 '0
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 r g construction and zoning.
Date
Signature
Owner or Agent
Date
ILA
z► (oc
APPLICATIO PROVED BY: P&Z t?fficial chc 6/18/03
°RSL Miami Shores Village
"'"='c+ 10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204 Fax: (305)756-8972
�'ioRii►A
Permit
Permit Status: APPROVED
Issue Date: 4/3/2006 Expires: 03/28/2007 Permit Number: PT-3-06-781
Owner's Name: DIANE WARD one: (305)757-7300
Permit Type: Paint Parcel#: 1132060172050
Work Classification: Miscellaneous
Block: Lot:
Job Address: 9830 5 AVENUE Road NE Section: PB:
Miami Shores Village, FL 33138-
Contractor(s) Phone Primary Contractor Total Square Feet: 0
VISCOUNT PAINTING& DECORATII 305-751-7164 Yes Total Valuation: $ 2,480.00
ommenE.- Re uired Inspections
EXTERIOR PAINTING
Final
Additional Information
Type of Work:Exterior Color:VELLUM,WHITE DOVE
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 $1.80 PT-3-06-24271 $68.90 $68.90
Education Surcharge $0.60 Total: $68.90
Notary Fee $5.00
Permit Fee $60.00
Technology Fee $1.50
Total: $68.90
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