PAINTAPPROVED:
EMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
/ (OWNER TO RETAIN COPY)
Date Job Address / 9 "% Folio 1) 3 a C)J / �� c/�''iJ J
Legal Description <T / � 5 �f,:e.,�'v� A TO 7/2/)4/77, 4/77,!' �S
/ DO S 0
' 8/ 2 — � S
Owner / Lessee Tenant Mast Permit t� 3 � v
5S S� ir�
Owner's Address l 92 �t/LT Phone
Contracting Co. Address
Qualifier SS# - -
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Zoning
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIG.
WORK DESCRIPTION / 1 7 (-17(11'61-7 �
Square Ft. Estimated Cost(value)
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DC
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTENI
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUF
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, an
on the attached addendum (if applicable). I certify that all work will be performed to meet th.
standards of all laws regulating construction in this jurisdiction. I understand that separat(
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 wil:
be done in compliance with all applicable laws regulating construction and zoning. Furthermore, :
authorize the above7}amed contractor to do the work stated.
//
/Signatur e of owner and /or Condo President Signature of Contractor or Owner - Builder
to • y s�� / Date:
Notary as to Owner and /or Condo resident Notary as to Contractor or Owner- Builder
My Commission Expires: Le,0n,r4 G77 - 40i My Commission Expires:
NOTARY PUBLIC STATE OF FLORIDA
MY COMMISSION EXPIRES 5/09/94
** * * * Bonded thru 43temblefAdams &'Sweet * * * * * * * * **
PEES: PERMIT 37.Z7 RADON C.C.F. / NOTARY 6792 TOTAL DUE
Mechanical Plumbing
Phone
Fire Other
Building '(JQ/I( /rte Electrical
Engineering
Qualifier
State #
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date t /42Job Address /�q2A/ 53 Tax Folio
Legal Description
Historically Designated: Yes No
Owner/Lessee / Tenant 0 $447p Master Permit # I/'7 7 C�
/ ®� et= 7� Owner's Address ` ��2/1�� �j� /��.� /�� Phone �—
/9
Contractin Co(' �6 Address 006V7
30 Jbq 7612/Municipal # /7P0 5 Competency # /7X6-
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Zq &?662
7xir
WORK DESCRIPTION
Square Ft. Estimated Cost (value)
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.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in- eo ance with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the, work stated.
0,-, 4,7/4
Signature of &s'ner and/or Condo President Date Signature (
Peggy Ann Beltran L
CO on CC839229
Notary : Owner and/or Condo President
My Commission Expires:
N AeiegLw2A SS#
1019
.x
Date
Ins. Co.
Notary as to Contractor or Owner- Builder
My Commission Expires: ,3 r) r
OFFICIAL NOTARY SEAL
MICHAEL H DUR
NOTARY PUBLIC STATE Of
COMMISSION NO.
MY COMMISSION EX
Date
0
FEES: PERMIT D RADON C.C.F. j - r) NOTARY ' ' BOND
L, APPROVED: TOTAL DUE t / ��
Zoning Buildin ' . / r' Ir f + Electrical
Mechanical Plumbing Structural Engineer
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE:
OWNER'S NAME:
ADDRESS: /: �>' !�. /n/97V
ADDRESS OF SITE: /0 q
CONTRACTOR & LICENSE (if aplica 1e) /7V 5 �
COMPANY NAME: O[ ,di/JJ774 PHONE:
All Elements on th ite must be listed and indi ate the color to be painted.
Walls CC b)gnc
Fascia
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
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 -n ed contractor, if applicable, to
do the work stated. Furthermore , the paint color . ril4 be as per the attached
samples.
Signature of Owner Date Signa
********* * * * * * * * * * * * * * * * * * * * * * * * * * * * *, ** * ** * * * * * * * * * * * * * * * * * * * **
WHEN AINTING IS FINISHED,
CALL FOR FINAL INSPECTION
APPROVED:
ii
Building Official
D ate
/a
0
r
AroP
ntractor Date