PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date(...5/)- / / Ol Job Address .0 (oc� Tax Folio
Legal Description Historically Designated: Yes No
•
Owner/Lessee / Tenant bhQrn/Yla V /4-ec r Ja-d �c.A Master Permit # 49/ / 0 y
Owners Address c367 Z 10 ' A A- Phone ( 305) 7-Y — ItV
Contracting Co. Cli Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company ry Address
Mortgagor /—/ i ;S 9 `v n'' Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE
WORK DESCRIPTION
Square Ft. y0 U s f Estimated Cost (value) 7._.0b
SIGN
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 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.
Signature
/ 1
No': as to Owner and/or Co
My Commission Expires:
FEES: PERMIT
APPROVED: '
Zoning (iC,
Mechanical
6 /a (
caner and/or Condo �der�t 3 Date g D � 0 � Signature of Contractor or Owner-Builder
Date
.. Gtr J J ! : Notary as to Contractor or Owner - Builder Date VIL
N'CITAttY PUBLIC STATE OF II_DRIDA My Commission Expires:
COMNIISSION NO. CC714103
, 1`! S ION EXP. L
RADON C.C.F. r V/ 0 NOTARY / BOND
5/ �� D' TOTAL DUE
411 Electrical
Plumbing Structural Engineer
• MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE: S r,2. cf 01
OWNER'S NAM A/ o i I .4 d °i A-b e e I 3 v 7 'S" 5 c/ a
ADDRESS: 36,S 3 F • 9 3 - a.-tL
************: tc********************* * * ** * * * * * *** * ** *** * ** * * * * * * * * **
. 3( S S ^-.2P
CONTRACTOR & LICENSE (if applicable)
ADDRESS OF SITE:
COMPANY NAME:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls }eJ c � fl lozye �2 — X31a X04 C
Fascia
Drip Cap/Drip Edge N (A.
Soffit
/4 ( Pr
sanxnes.
Roof
Flower Bins
Shutters •
Awnings
Chimney
Doors and door jams c_p_ � l—
Garage Doors
Railings
Fences
Decorative Metal
All brick (simulated or regular) YY
Stucco Banding
Any other stucco features
Accessory Buildings
Other
PHONE:
1/A
bra ck54 - - ri m
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
Sd -cVol
Signatu e of Owner Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED: WHEN PAINTING IS FINISHED,
// CALL FOR FINAL INSPECTION
Building Of cial Date
4/23/01
925