PT-16-3332Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
PAINT Master Permit No.
PERMIT APPLICATION Sub Permit No.
-7 Lq NE 9 6 -°5 "1 ---
City: Miami Shores 7-016f
County: %% Miami Dade Zip: --3)1 35?
Folio/Parcel#: 1, / "" 3 2 b Lt - 0 1 1 -• 1 wilding Historically Designated: Yes NO
OWNER: Name (Fee Simple Titleholder): e G' (j \ CI NSb >--N Phone#: 3 c [ O aD- g q
Address: 7 -7 Li NF ick
City: (a rY1 i (3--s 1,10 rC S State: FL - Zip: 3 31 3 g
JOB ADDRESS:
RECEIN D
DEC 0 9 2016
Fsc io 14 5141
Qi-' -333Z
Tenant/Lessee Name: e,,,,,,,,,,,Email: rd( 'e5 (i ,---,l OtV1 So ,(1 2 O C 3 ,
CONTRACTOR: Company Name: 61113 Phone#:
Address: N
t M
City: State: Zip:
Qualifier Name: Phone#:
Phone#: 5 -7 g g aag`1
State Certification or Registration #: Certificate of Competency #:
Value of Work for this Permit: $
` S v b • 45-D Square/Linear Footage of Work:
Description of Work: l a ( d vV-C ✓ >i a S r' s G r& v7
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, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS,
HEATERS, TANKS, 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 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 an inspection fee will be charged.
Permit Fee $ b0 CCF Fee $ 1 . 20 Notary $
Technology Fee $ 1 • bo Training/Education Fee $ O .4 ( Double Fee $
TOTAL FEE NOW DUE $ p P
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: 1
2
3 4
2
3 4
Drip edge: 1
2
3 4
Soffit: 1
2
3 4
Flower Bins: 1
2
3 4
Shutters: 1
2
4
Awnings: 1
2
3 4
Chimney: 1
2
3 4
Doors & Jambs: 1
3 4
Garage Doors: 1
2
3 4
Railings: 1
2
3 4
Fences: 1
2
3 4
All Brick: 1
2
3 4
Stucco Bands: 1
Other Stucco
Feature:
2
3 4
1
2
3 4
Accessory Bldg: 1
OWNER'S AFFIDAVIT:
applicable laws regulatin
2
3 4
Signature
ertify that all the foregoing information
construction and zoning.
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of - C , 20 / (...,• , by
0C)Nc c ` cA n M \v\so N , who is personally known to
me or who has produced ri \1%(1( (.1 N. i $-C as
identification and who did take an oath.
Sign:
Print:
Seal:
APPROVED BY:
YANADY PRIETO
MY COMMISSION # FF 214031
EXPIRES: March 25, 2019
Bonded Thru Notary Pubic UndeomMers„
Attach color sample with name and number
is accurate and
that all work will be done in compliance with all
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of , 20 , by
, who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
4602-- (( Ltode Official
Historic Preservation Board