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PT-17-551Miami Shores Village REcET'� (e, Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: PAINT Permit No. MAR i 3 2017 Master Permit No. OWNER: Name (Fee Simple Titleholder): '�.JVL' 14 P3 Z5TOPs A'( C Address: 63 bLd DL 2,)1d Ave. City: fi1A-41/ W*)P-L-SS State: Phone#: (30 S-) 5?" c- Zip: 3 3? 3e Tenant/Lessee Name: Phone#: Cc) 13)Q 7'_ goVS Email: JOB ADDRESS: /0/9 G `- 59-- City: Miami Shores County: Miami Dade Folio/Parcel#: l 1 aJ 266 —61 y 3 5-go Is the Building Historically Designated: Yes NO x Flood Zone: CONTRACTOR: Company Name: CI 7V 1266 106 Ce'x.953fi2tiedC/XJ.Ite zip: 3 313- .zS`-1 Phone#: (36 ) 86 ?— c 6 Address: oZv296o 560 1 `vZ e City: / ALZ % State: Pt Zip: 3 32 9-6Qualifier Name: '-`I1&e 1-t 4p, Phone#: C 3 -) 86 ? S State Certification o/j,Registtration #: CGC es-0 93 65- Certificate of Competency #: Contact Phone#: t ) Sob — 1 l Email Address: Value of Work for this Permit: $ -,©e Square/Linear Footage of Work: ' do �r Description of Work: PC/C ✓l QC 6(}1.0/ Y' carlis j l`'a-w« jAtoPt2415 j /9 r> 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 "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. ***************************************Fees******************************************** Permit Fee $ (oO CCF $ I . 80 Notary $ Training/Education Fee $ a ' 6/ Technology Fee $ 2 . ¢0 Double Fee $ '��— TOTAL FEE NOW DUE $ (04 . Sf� 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: ll/ Fascia: Drip edge: 1 Soffit: 1 Roof: 1 2 2 2 2 2 Flower Bins: 1 2 Shutters: 1 Awnings: 0 Chimney: 1 Doors & Jambs: 1 Garage Doors: 1 Railings: 1 Fences: 1 All Brick: i5 2 2 2 2 2 2 2 2 Stucco Bands: 1 2 Other Stucco Feature: 1 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 Accessory Bldg: 1 2 3 4 Attach color sample with name and number SW 6002 Essential Gray 240-C2 OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work w' : : • e in compliance with all applicable laws regulating construction and zoning. Signature. ner o !ent The foregoing instrument was acknowledged beforemeis day of 1� , 20 L by 6e t � ��� ` �7 L _- is personally known to me or who has produced RICARDO IRIARTE As identification and who did take an oath. ommission Expires: ***************************************** * [COVED BY: Signature: or The foregoing instrument was acknowledged before me this day of Afve d/`� , 20 / ,�y if/ O 4444 who is personally known to me or who has produced as identification and who did take an oath NOTARY P ; LIC: rC.•.-e.,2._ A-k. Sign: w Print: ECs-t My Commission Expires: *************** ****1** *********************,* / 7 Code Official Preservation Boa MY COMMISSION #FF088736 EXPIRES February 2. 2018 yo:.• 4Q'•, t•Oh . �tP. F to ri da NotaryService.com 7)398.0153