PAINT PERMITTO:
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COMPLAINT
Telephoned
Came into Village Hall
FROM:
SUBJECT: 3 S' L / /
DATE: /Ve TIME: / /:°z5
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MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE:. °,2 3` o r
OWNER'S NAME: Ll r , ► , PHONE: _ 7,S7.579 3
ADDRESS: ti -E, S T
* * * * * * * ** * ** ****************** * * * * * *( * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: 7 1t �' Q( c'
CONTRACTOR & LIC NSE (if app1 able) ,94 cx) Z -/ cl
COMPANY NAME: V IS WAIT l i r,v6 PHONE: -7 -
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All Elements on the site must be listed and indicate the color to be painted.
Walls 15/ q0
Fascia b)4
Soffit o t,[.tr
Roof 6,
* Al�A
Flower Bins
Shutters �J l
Awnings i
Chimney Al A-
Doors and door jam , Wt(--t're
Garage Doors ule
Railings
Fences n(
Decorative Metal tc) -(
All brick (simulated or egular) 11,1 Stucco Banding kj 7c �-
Any other stucco features
Accessory Buildings
Other
OWNER'S AFFI 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. I authorize the above -named contractor, if applicable, to
do the work stated. Furthermore , the paint • will be _per the . ched
samples.
rc)0 — ILL
ignature of Owner Date Signature of Contract Date
,...,, 21:******************************************** * * * * * * * * * * * * * **
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
APPROVED:
Building Official Date
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0
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Owner's Name and Address
Registered Architect and/or Engineer
Name and address of licensed contractor
Location an d lle 1 description of lot to be built on:
Lae 4- 11../1--.5 --
Block A
Street and Number where work is to be done
STATE OF FLORIDA
COUNTY OF DADE.
Permit No.
Disapproved
(Signed)
f9// `i-v.1(
}SS.
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Subdivision ,Y
3 3 /1/45 9/ 1f
State work to be done andpurpose of building (by floors), state exterior colors (submit samples)
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation
Estimated Tata] cost of improvements $ /3 6 Amount of Permit 5 5 2' 5-0
Zone cubage required Plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all plans and specifications for said building. All notices with reference to the building and its construction may be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons as an employer of Labor under the Florida Workmen's
Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar
compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit: and will post or cause to be posted for inspection
on the site of the work such public notice or notices as are required by the Act. The undersigned a! ees to employ only such subcontractors. on work to be
under this permit. as are licensed by Miami Shores Village. i
Remarks (Sign d� 1 / i u'
Before me. the undersigned authority. a notary public, duly authorized to administer oaths and take acknowledgments. personally appeared
to me well known.
and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction. that he has carefully read the foregoing application, and that he did sign the same. and that all facts therein by him stated are true.
Date
r )RES VILLAGE
A CTION DEPARTMENT
R BUILDING PERMIT
/O
Date
Read. Sworn to and Subscribed before me.
Notary Public, State of Florida
l e plans and specifications herewith submitted for the building or other structure herein
g ilding Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the
ations of the Building Division of Miami Shores Village shall be complied with. whether
ept at building during progress of the work.
Date 0/, 19 g7
No. 3.5- y Street
Roof Covering
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date' Disapproved Date
NOTE: A charge of 525.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board.
A re- inspection fee of 525.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.