1249 NE 91 Terr (3)Date Id 2 / Job Address 4 /0 ,7 l - 7 Tax Folio
Legal Description "� Historically Designated: Yes No
Owner/Lessee / Tenant S /7 Aq - / f� �- j e S Master Permit # q5 q 7 /
f
Phone
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Owner's Address /,32 -Vq ^ 4.1 /
O u /,t(F
Contracting Co.
Qualifier SS# Phone
State #
Permit Type (circle one): BUILD
WORK DESCRIPTION
TZ4
P�� J
APPROVED:
Zoning
Mechanical
My Commission Expires:
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
Architect/Enginccr
Bonding Company
Mortgagor Address
ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Building 4 a Mitt hit j
Address
3)E V5 >-
overlong
�o.
Square Ft. Estimated Cost (value) / -
/
C) C%
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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.) •
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work
will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL
PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that al o will be done in compliance with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor tc}ido the
FEES: PERMIT �- RADON C.C.F. 0 NOTAR
`z z1
ctor or • er- Builder ate
/ ? /7
otary as to Cori tor or Owner- Builder Date
My Commission Expires:
Electrical
TOTAL DUE
Plumbing Structural Engineer
Date
Miami Shores Village
Paint Color Approval and Agreement
Phone #
Owner's Name
Owner's Address
City State Zip
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 #
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All elements on the site must be listed and indicate the color to be painted
Walls
Fascia
Drip Cap /drip Edge
Soffit
Roof
Flower bins
Shutters
Awnings
Chimney
Doors and door jams
Garage doors
Railings
Fences
Decorative metal
All brick (simulated or regular)
Stucco banding
Any other stucco features
Accessory Buildings
Other
Attach Color Samples
With Numbers
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
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& Z Official
chc 6/18/03