PAINT PERMIT• • 1
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PERMIT APPLICATION FOR MIAMI SHORES VILLAGE ,
Date' //O S / g Job Address j 3 /\/t= C')1 141 C I Tax Folio
Legal Description Historically Designated: Yes / , No
Owner/Lessee / Tenant ��R) IN/ s i ?, Master Permit # ` 1 3 7 3
Owner's Address 37 ki F ) f-1) ST- Phone C 3, 7 3) 7 /�ka t 7:
Arlrlrp.c
Contracting Co. C V■ 1 1
Qualifier
State # Municipal # _
Architect/Engineer
Bonding Company
Mortgagor
Signature of owner and/or Condo President Date
APPROVED:
Zoning Building
Mechanical Plumbing
Electrical
Phone
Ins. Co.
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOM PAVING FENCE SIGN
4 IA/
WORK DESCRIPTION ' / �iy /�9 . if' • �..� i / - , -
p , 0 du S CI o "(2 -c / 6T
Square Ft. Estimated Cost (value) g 5 0 0.
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
r 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 all work will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
or or Owner - Builder ate
/ /.. ,
1
1 1 . - .,
Imo. i i r.�. -- - --
Notary as to Owner and/or Condo President Date /Not ' �' l wild
My Expires: Commission E ires: My o 's � _. �t ? - �
is a ierne .B ohy
Date
FEES: PERMIT L' RADON C.C.F. (p NOTARY BOND
TOTAL DUE
Engineering
Miami Shores Village
Building Department
BUILDING
PERMIT APPLICATION
FBC 2001
RECEDVED
JUL 2 2003
-19450 4 E.2rd venue
mi Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No. P2 U9C( •
Master Permit No.
Permit Type (circle Building 'Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) 6 LL Phone # ( Tn ) 7s 710 O S
Owner's Address -7 3 n/ L C\ 1 S
City / l ,t , Q (r State F1 Zip R 'j i
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 7F g / S
$ Value of Work For this Permit
io C\z_ $910 Varil,
City Miami Shores Village F County Miami -Dade Zip 3 1 3 g
Is Building Historically Designated YES NO X
Contractor's Company Name ee-C..f � rl` � �J2 71,0,n f)) Phone # 0 3 J 5 9 7c
Contractor's Address
City State Zip
Qualifier
Architect/Engineer's Name (if applicable) : Phone #
Architect/Engineer's Address
City State Zip
Square Footage Of Work:
Number of: Bays Stories Families Bedrooms Baths
Type of Work: ['Addition ❑Alteration `may l ❑New ❑ Repair/Replace ❑ Demolition
Describe Work: E� I ` lc��tC). O ► l-� J��
P
* * * * * * * * * * * * * * * * * * * * * * * * * ** *Fee Calculation -Misc Permits * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
S. CC
County Escrow Fee $ Permit Fee $ @� • l_J�_J Notary $
Education/Training Fee $ 6. GO. Tech $ Scanning $ Radon $
Code Enforcement $ Bond $ Struct. $
Minus Plans Check Fee $ Fee Totals $ 5. GO • (Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding Company's Address ~
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
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
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.
"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 a reinspection fee will be charged.
Signature C ��
Owner or Agent /J
The foregoing instrument was acknowledged before me this 2)
day of , 20 (, byH b Y c h
who is
ersona
Print:
chc6 /18/03
y known to me or who has produced
My Commission Expires:
As identification
NOTARY PUBLIC:
( aces November 15, 2008
Sign:
Print:
My Commission Expires:
9,1 L510 ** ********************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
JUL - 9 2003
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.
2
Plans Examiner
Zoning
.
DATE:
OWNER'S NAME: . Z. ,1. HONE •S q 76 0_5
ADDRESS:
************************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: � - S ‘g S1 - 04e . r
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls n
/ /,i
Awnings ,/,-
Chimney
samples.
leLb
atu
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
Fascia
Drip Cap/Drip Edge %rig -
Soffit
Roof !
C Flower Bins ' /,.j C
Shutters
Doors and door jams 4f
Garage Doors ,AM
Railings IVA
Fences_ _ a _ /VA
ecorative Metal �� , 4 r,. -' 4 d Ce' • - 7
s
simulated or regular) simulated / tiff f m
w X O
Stucco Banding A, w
Any other stucco features //A
Accessory Buildings il /
Other i s•o _5 e-c c () 4 3
t,0 ' ) ' L
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. I authorize the above -named contractor, if applicable, to
do the work stated. Furthermore , the paint colors will be as per the attached
Building Official Date
( 0
0
0
\I
Q7 /& 0 3
Siy�n Owner Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED: �' `T WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01