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PAINT PERMITI • BUILDING PERMIT APPLICATION FBC 2001 e . L Permit Type (circle): uilding Owner's Name (Fee Simple Titleholder) Owner's Address City � � [ �}YY l e)2C)State f' Tenant/Lessee Name Job Address (where the work is being done) City Miami Shores Village Is Building Historically Designated YES Contractor's Company Name C,t, /V/ ly`L Phone # Contractor's Address City State Zip Qualifier Architect/Engineer's Name (if applicable) S Value of Work For this Permit ) -' Type of Work: ['Addition ❑Alteration Describe Work: Total Fee Now Due $ (Continued on opposite side) Submittal Fee $ Permit Fee $ Miami Shore:3 Village Building Department 10050 N.E.2nd Avenue, Miami ;shores, Florida 33138 Tel: (305) 795.2204 Fax: :305) 756.8972 i Electrical /!ti°J fc_ � � ` Phone # 7t`/ t .. ( J 22 1aa .4) q 3 sr Zip 232 ) County Miami -Dade NO t.• -- ['New ( Plumbing Master Permit No. Phone # Square Footage Of Work: * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** (i).0car r Permit No. --- 1))•i) r_C•L Phone # Mechanical Roofing Zip ❑ Repair/Replace ❑ Demolition CCF $ C. $ CO /CC Notary $ -DC) Training/Education Fee $ , �� Technology Fee $ t . ,',7C Scanning $ Radon $ Zoning_ Bond $ Code Enforcement $ Structural Plan Review. $ 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 ar a reinspectionf will be charged Signature NOTARY PUB Sign: Print: My Commission Expires: APPLICATION APPROVED BY: Chc 12/15/03 Owner or Agent G The foregoing instrument was ackn • Fledged before me this t 1 day of C l' , 20K, by I ' 6 C TOO who is pe onally known to me or who has produced Lek. As identification and who did take an oath. � �� �� pg � S NOTARY PUBLIC: omml + n0D231984 Sign: xpires: u , i 7 r Bonded Thru Print: Atlantic Bonding Co., Inc. (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. **************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** .d*************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 6 '(" 4 -p - 005/ Signature My Commission Expires: Lk( 7\0 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. Plans Examiner Engineer Zoning .. • Date • Owner's Name Owner's Address City State Zip Job Address (where the work is being done) City Miami Shores Village County Miami -Dade 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 Miami Shores Village Paint Color Approval and Agreement C Soffit (Z Drip Cap /drip Edge 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 ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 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 construct. and zoning. Signature APPLICATION APPROVED BY: er orJgent P& Z Offic Phone # Zip Date Date Miami Shores Village A 0 . ' 1 Approval and Agreement . Paint Color pp reement g Date ---X)34-(p-Axi- Owner's Name —7-7/,4 Phone # / � r-- J Owner's Address j 2 2- c., N< , ?....„80, City / /A 1 .c64. N245 State Zip `2., 1 " Job Address (where the work is being done) S 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 � p c Drip Cap /drip EdgSoffit Roof Flower bins Shutters Awnings Chimney Doors and door jams Garage doors Railings Fences Decorative metal With Numbers All brick (simulated or regular) Stucco banding 4 r Any other stucco features r X p Accessory Buildings �j Gt P Other ,Ok *********************************** * * * * * * * * * * * * *, * * * * * * * * * * * * * * * ** t 6 * * * * * * * * * * * * * * * * ****** ** ** * * ** e all OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compli applicable laws regulating construction and zoning. b e ye 67 Signature APPLICATION APPROVED BY: chc 6/18/03 Miami Shores Village 'Paint Color Approval and Agre PFEW Owner's Name / /GL� L'�� Phone # Owne r's _ .. , Owner's Address City 44 / /i)97 511 State Zip 3 13 3 Date 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) Phnne ******************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * *) All elements on the site must be listed and indicate the Walls Fascia Awnings Chimney 2 Drip Cap /drip Edge 2- Soffit Roof iA ..;: ' i - S: Po a io ‘,\ Flower bins . �`m Shutters Doors and door jams (G� Garage doors Railings Fences ' A-7 • Decorative metal All brick (simulated or regular) c) Any other stucco features _) Aitk Stucco banding Accessory Buildings Other Signature APPLICATION APPROVED BY: er or Agen i P& Z 1 Body: Pale Sagebrush ECC -38 -1 2 Trim: Icy Tundra ECC -38 -2 3 Accent: Sea Fern ECC -38 -3 Date Date 2 ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** OWNER'S AFFIDAVIT: I ce s t all the forego p information is accurate and that all work will be done in compliance with all applicable laws regulating cons n and zoning. chc 6/18/03 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 4/13/2004 Applicant: TIM TIERNAY Owner: TIERNAY TIM JOB ADDRESS: 1226 NE 93 ST Contractor Local Phone: Parcel # 1132050270170 Signed: (INSPECTOR) Building Permit Permit Number: BP2004 -487 Contractor's Address: Legal Description: BAY LURE Page 1 of 1 Permit Status: APPROVED Permit Expiration: 10/6/2004 Construction Value: $500.00 Work: ' PAINT E XTERIOR OF HOUSE AS AGEED PB 44 -63 LOT 4 LESS W25FT & W5OFT OF LOT 5 BLK 2 Fees: Description Amount FEE2004 -3942 Building Painting Fee $60.00 FEE2004 -3943 CCF $0.60 FEE2004 -3944 Notary Fee $5.00 FEE2004 -3945 Training and Education Fee $0.20 FEE2004 -3946 Technology Fee $1.50 Total Fees: $67.30 Total Fees: $67.30 Total Receipts: $67.30 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: