PT-06-3067 Ar
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01117107UL� Miami Shores Village0 MCTICTM
Buil.�ing Department artment DEC 2 6 2006
..
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY; ____,
Tel: (305)795.2204 Fax:(305)756.8972
BUILDING PermitNo. -
PERMIT APPLICATION Cl Master Permit No.
FBC 2004
Permit Type(cirCle): BuildDingElectrical Plumbing Mechanical Roofing
Owner's Name(Fee Phone#
Owner's Address
CityState Zip
Tenant/Lessee Name Phone#
Job Address(where the work is being done) (box N6 2
City Miami Shores Village County Miami-Dade Zip
FOLIO/PARCEL#
Is Building Historically Designated YES NO
Contractor's Company NameM/-1 0y Phone#_� 5 1 Z—2 ZOS
Contractor's Address bq0rJ SLU W2
City Pajtkj.Lt_ Zip--331-7C
Qualifier Name ,10 Phone#
State Certificate or Registration No. Certificate of Competency No. PIS(I I 55q
Architect/Engineer's Name(if applicable) Phone#
�O•
Value of Work For this Permit$ .2 Square/Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration E] Repair/Replace ElDemolition
Describe Work• �(Vew
Submittal Fee$ Permit Fee$_Leo 0� ' CCF$ CO/CC
Notary$ Training/Education Fee$ 5- Technology Fee$
Scanning$ Radon$ DPBR$ Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due$ VV
OV
See Reverse side—� 11� 18
PAID
Bonding Company's Name(if applicable) /
Bonding Company's Address '
City State 10� 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 arei p ction fee will be charged
Signature �r Si a
O peror Ag t `{ Contractor
The foregoing i ent was ac /ledged before me this (L_ The foregoing instrument wwle
s acknod d`nberfore me Ai�
day of DJC ,20 66,by /'f� day of 2& by -I 6SIcai-a
who. erson y know o me or who has produced who is personally known to me or who has produced-'D .
As identification and who did take an oath. I ID - as identification and who did take an oath.
NOTARY PUBLIC: NOTARY P LI ;, Yp Mabel Vargas
gas
#_Commission#DD231484
Sign: p �D` �4; Sign: Ex ireS:Jul 13,200,
Print: ON�C�C M'10 �o `"° Print: A '!tic Ondine 1
My Commission Expires: f My Com ission Expires:
APPLICATION APPROVED BY: ( >! 7 Plans Examiner
Engineer
Zoning
(Revised 02/08/06)
Miami Shores Village "
Paint Color Approval and Agreement
Date:
Owner's Name: Phone#:
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#:
...............................................■.............................■1
All elements on the site must be listed and indicate the color to be minted
Walls: P-" or- Crete yc \\,1 w
Fascia: Tc,a,.s-,,p Ls Attach color Samples
Drip Cap/Drip Edge: ` `��S�cF c� �r c�,�
with numbers
Soffit:
Roof:
Flower Bins:
Shutters: �<-
Awnings:
Chimney: V-e�
Doors and Door Jams: y"0b C?
Garage Doors: `11
Railings:-
Fences:—
Decorative
ailings:Fences:Decorative Metal:
All brick(simulated or regular):
Stucco Banding: f3,,,
Any other Stucco Features: r t�p
Accessory Buildings: ►S �r>
Other: aSw CIx 11 3.,-�,Jp
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: Date:'~
P&A OFFICIAL
**MUST BE ATTACHED WITH PURPLE BUILDING APPLICATION**
Rim* i
310D
31OD-4 r
Gold Buff MW
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GA,
Bronzetone 60
3600 ro
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ME
Rill, .
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360C-1
Clear Yellow
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71
W-D-200 u
Pot of Cream
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