PAINT-05-19-991 CanceledRECEIVED
Miami Shores Village IY 0 3 2019
g PY
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 WCELLED Permit No. {�v ( � -�q
PERMIT APPLICA��pl,, b 4Master Permit No.
FBC20 KF--o9-21-7380
Permit Type: PAINT ' n I 7
OWNER: Name (Fee Simple Title older): �/ `� 1 Z�A `L l Phone#: f �� '' ���
Address:
City: IV aC State: Zip: 7 3
TenanVUssseee Name: Phone#:
Email: 2R I G4- (AV1
JOB ADDRESS: %OS_/% !%�� O�h 9t'z: p
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes NO Flood Zone:
2a3
CONTRACTOR: Company Name: /J/ (�P,i� �9ihfirnt� WPhone S�l s%3l� ��
/�#:
Address: / 7J_ c' h //�VW_. 424AMi ST
City: L"OCfJh✓�yL� �ZC!/l State: CG Zip: 35e73
Qualifier Name: Phone#: /��/
State Certification or Registration #: �C t (O -,q/- / //-Xf Certificate of Competency #: /7,gS OOD-/7
Contact Phone#: '�i �O�- tj %�� 3 7L_Email Address: I 6�!
Value of Work for this Permit: $610 Square/Linear Footage of Work: fj'iSCi.
Description of Work: 11�076v_ A.1SXv/1v 'd'
Application is hereby made to obtain a permit to do the work and installations as indicated. I ce y 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 most be posted at the job site far the f rst 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.
rsxszxe#ses*x�zax♦x�xx�x■szxxs►rrr:s`*x*Fees**xxx�*s►■exa�xa•�►xrzx�xa*�w�xtxexmas�>k�tx�
Permit Fee $ CCF $ Notary $ Training/Education Fee $
Technology Fee $ Double Fee $ TOTAL FEE NOW DUE
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: 1
2
3
4
Fascia: I
2
3
4
Drip edge: 1
2
3
4
Soffit: 1
2
3
4
Roof: 1 %<
2
3
4
Flower Bins: 1
2
3
4
Shutters: 1
2
3
4
Awnings: 1
2
3
4
Chimney: 1
2
3
4
Doors & Jambs:1
2
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
2
3
4
Other Stucco
Feature: 1
2
3
4
Accessory Bldg: 1
2
3
4
Attach color sample with name and number
1. Cry SC2FF 17
5'w 7-7
23SC1 23
3. SW 7071
Gray Screen
4.
OWNER'S AFFIDAVIT: I certify t all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulatZnsand zoning.
Signature: Signature: ✓
Owner or Agent t Contractor
The foregoing instrument was acknowledged before me this S The foregoing instrument was acknowledged before me this-iff
day of VICM 20191 ,by S �f1At \/ tAV-I dayof HOLI ,20L9 ,by MGrwg
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: -W&
My Commission
NOTARY PUBLIC:
Sign:
lY VEm LIST ro Print. 7ffl[�
Commission N GG 050483 My Commissllify Public - State of Florid
My Comm. Expires Nov 28, 2020 ommission aN GG 050483
Banded tnrouah National Notary Assn.Comm. Expires Nov 28. 20.
Preservation Board
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