PT-09-575Miami Shores Village
Building Department
10050 N.E.2nd Avenue. Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax:
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: PAINT PERMIT
I ��
Owner's Name (Fee Simple Titleholder) N'`,�;��v� f�� �v Phone # v� �")c;!
RECEIVE
AP'0;2009
_I;.�,�
(305) 756.8972 q
Permit No. F V ` —515 5
aster Permit No.
Owner's Address tc P -
City '�4C�LS State VL Zip 331 �[3
Tenant/Lessee Name
E-MAIL:
Phone #
Job Address (where the work is being done) 1G to -2,g9
City Miami Shores Village
FOLIO / PARCEL #
County Miami -Dade Zip -33
Is Building Historically Designated YES NO 'X
Contractor's Company Name N014 (/, Owl leiPhone #
Contractor's Address ��
City State rt Zip
\ .
C4
Qualifier Name %3?4
Phone #
State Certificate or Registration No. Certificate of Competency No.
OWNER BUILDER: Ye 5
Value of Work For this Permit $ Type of Work: ❑ Addition / ❑ Alteration / ['New / ❑ Repair/Replace
Describe Work: nA k f - AM-, ---to-vc.Tu ---\-\ cr,',E
Application is hereby made to olxain a permit to do the work and installations as indicated. 1 certify that no work or installation has commenced prior to the issuance of a permit
and that all wort: will he performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must he secured for
EI.HCTRICAI WORK. PLUMBING, SIGNS. WELLS. POOLS, FURNACES, BOILERS, BEATERS, TANKS and AIR CONDITIONERS, ETC
"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 OB'T'AIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to .-Ippl ..4.s Asa condition to the iss,ranc•e of a h„ilding permit with an estimated value exceeding $2300. the applicant must promise in good faith that a copy of the
notice of commencement and construction lien Icer• brochure will be delivered to the person whose properly is subject 10 attachment. Also a certified copy oldie recorded nonce
of connnenceinenl must he posted at the job site for the f rsl inspection which occurs seven (7) days after the building permit is issued. In the absence gfs'uch posted notice. the
inspection will not he approved and a reinspection. fee will he charged.
rx>.>.rx xxxr xxxxxxxxxxW**************Fees********************************************
Permit Fee $
Training/Education Fee $
$z(.i�
j ary
Double Fee $ ZoningA APR 2 :73
CK t22.
MIAMI SHORES VILLAGE
Technology Fee:
1� 5b
Code Enforce �tt $
IFee Now Due $ Pi -6D
See Reverse side —*
PAINT COLOR APPROVAL AND AGREEMENT
All elements on the site must be listed and indicate the color to be painted
Directions: Please circle corresponding number to appropriate color sample.
Walls:
Fascia:
Drip Cap/Drip Edge: I
4
Soffit: 1 U 3
Roof:
3 4
Flower Bins:
3 4
Shutters:
4
Awnings:
2
3 4
Chimney:
Doors and Door Jams:
4
c�
4
Garage Doors: I 2 () 4
Railings: 1 2 3 4
Fences: 1 2 3 4
All brick (simulated or regular):
Stucco Banding:
Any other Stucco Features:
3 n 4
Accessory Buildings Other:
Attah_cnlnr_camr�.lcc_w_ith_n_Mne and
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.
Signatt
wncr or Agent
Signature
Contractor
The Co egoing in: rumei --qwas acknow dged before me this 8 The foregoing instrument was acknowledged before me this
day of_op __.20bt.by_ �jI(L j1 'Pic!
Porc! day 01 .20 .hv
who is personally known to inc or who has piuduced fl • L„�V j
IACI)MetO fir: identification and who did tam ' oath.
NOTARY' r.
Sign: I/17*%41111a
Print:
My Commission t.lxp
******************
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
**************i*************************************************************
APPLICATION APPROVED BY: , Plans Examiner
Preservation Board
4 e l Ui Code Enl<ircement
(Revised 04/24/0