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117 NE 95 St (4)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE • F Job Address // 7 /1/4 f5 c . Tax Folio . eAl'791 Owner's Address Jain , mss o 1/ Historically Designated: Yes No Master Permit # 754' .23 o 9 Phone Contracting Co. I) 9T e !' Address Qualifier SS# 73 — 4 , 2 3 U C State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION & Zki k( c Square Ft. Estimated Cost (value] 67 c ' v ' 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 of owner and/or Condo President Date Notary as to Owner and/or Condo President Date My Commission Expires: FEES: PERMIT 4 RADON Signature of Contractor or Owner- Builder Notary as to Contractor or Owner -Bui der My Commission Expires: , PU OFFICIAL NOTARY SEAI- O. - <" BARBARA ANN FUCAZZI ; >r O COMMISSION NUMBER g ' CC360191 4 � MY COMMISSION EXP. BF F C.C.F. cD NOTARY ( TOTAL DUE 4 ��193 — Date Date APPROVED: Zoning Building Electrical Mechanical Plumbing Engineering MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with. whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. ]'"� ,, D � �/J Date ( P 19 9 °— Owner's Name and Address ‘. } e) S e. _ " ' 61 W No. � ( 7 � Street No 9f ST Registered Architect and/or Engineer �I ^� Name and address of licensed contractor SC(N / e (�� ' T 3 EC (L// e/i-r / 3 39 SG✓ " s % Location naand�/legal escriptio lot to be built on: �yy� �(� J Lot d / I1/ 4 Subdivision //u g / t / 1/ Ja, /3 o 7J/ b Street and Number where work is to be done , / 7 Ai / S / State work to be done and purpose of building (by floors), state exterior colors (submit samples) 1 (04 f AN, L_h T r / and for no other purpose. New Building Remodeling ✓ Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering i5O biz Estimated Total cost of improvements S 3 D J Amount of Permit S 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 \'lorkmen'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 agrees to employ only such subcontractors. on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA COUNTY OF DADE. J ss. 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 foregoi . g application, and that he did sign the same, and that all facts therein by him stated are true. Permit No. 30Z Date V # Read. Sworn to and Sybscribef. e me. Disapproved A 1 . \\ ► 1 Date ° Notary Public, State of Florida NOTARY PUBLIC STATE OF FLORIDA (Signed) 1, �/vvw w• v MY C OMNISStON r My Commission Expires E P. NOV 23,1990 PLANNING BOARD DATEBOUOED THRU GENERAL ENS. UkD, Building Inspector 2 /70 f J/ 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;gr workmanship. 1 Square Pt. 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 -nam cpntraczor to d� u WJLk stated. "� ""ei JOS EPHINE HUR H :%NotaryftwicligeoffloWs t Date Job Address /1, JUT 9 S7 Tax Folio / 3 � p / c2730 Legal Description G 1' /7 tV ? /9 a Rik o?i9 / Lessee / Tenant JOSGP# C/` 1 Owner's Address 1/7 /I/E 9._5" s7 Contracting Co. ,8y QJ.t/e,e Address Qualifier / SS# - - Phone State # Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDIN ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION /P/;V77;(/6- ii/ u e ( G #) ) 4 /4 Os or4'- Signature of owner and/ Date: 7,4g PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 2ar ,4 Prue type or scamp name of Norary Public Jr' � "`� �� I son. Utv k o�v<< DOR Produced as to Owner and ' o a r in g¢tOMIa ced: My Commission Expires: ** * FEES: PERMIT ,475 APPROVED: L D DID rake an oath, or (513, DID NOT take an oath. * * * * * * Zonin Mechanical Plumbing_ Master Permit # Estimated Cost(value) c2!/0 Phone (39 7.ry-023O 00 Signature of Contractor or Owner- Builder Date: Notary as to Contractor or Owner- Builder My Commission Expires: * * * * * * * * ** RADON C.C.F. _ ., 4 NOTARY S71919 TOTAL DUE ? o 0 Fire Other Electrical Engineering PROPERTY OWNER me RO..i Lk etA \ Address 1 , ' ` L 9 ST- IV t4An S' LW AL 33t3k i Home Telephone 6s- ¥c 004C V 0 Business Telephone 3 0,r q C 1 � l o w Q 1 Fax Fax 3 4.) S `5 3 `f TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add't Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit- ted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION Job Address: „F NE -1 S S t Address PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Ap Folio Number Lot Block Subdivision PB PG Current Use of Property Proposed Use of Property Tenant Information PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. 1(� q.w►i City !! escription of Work 1 hT r 33t 38 State PERMIT APPLICATION Zip Zoning Linear Feet Square Feet Units Floors V alue of Work _` U C i U T Assessed/Appraised Value Flood Zone Base Floor Elev. Bldg Value ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name Page 2 IMPORTANT NOTICES 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 pin., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. 4. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1 Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Cho ng a Contractor. gnature SEAL: , COUNTY OF MIAMI -DADE My Commission DD150048 Expires November 15, 2005 Personally know OR, Produced Identification STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Contractor / Qualifier Print Name Sworn to and subscribed before me this day of c - State o ela Mj a t Signature of Notary Public - State of Florida SEAL: PERMIT APPLICATION Personally known OR, Produced Identification Type of Identification Produced: Type of Identification Produced: ELECTRICAL TYPE. Minimum Fee Q'I'Y. TYPE Dryer QTY. TYPE. Outlet, Appliance ()Ty. Tvi'i; Service Repair QTY. A/C Central 1 -3 Ton Dryer Vents, Number of Fan Ventilation, Cost Outlet, Wall Ductwork, Cost of Service, Temporary Periodic Inspections A/C Central 4 -7 Ton Fire Sprinkler System Fire Pump Outlet, Switch Fireplaces, Number of Signs A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL TYPE QTY. Minimum Fee TYPE Condensate Drain QTY. TYPE Generator QTY. TYPE QTY. Refrigeration, Toots A/C Central, Tons Cooling Tower - Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE, Miscellaneous Fixture QTY. TYPE Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Draintield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: SECTION BY DA�T'E ///1 / // Zoning / Electrical ° Mechanical Plumbing Fire Public Works Structural 11177t."2-% Building Official Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERNIIT FE . $3.00 per page (Scanning Fee) $ Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine $ Zoning Review Notary $ '$ 6O ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: (X .ft. = X/1000 (0.005 /sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.mianiishoresvillage.com lVll� 1 ori.._tia.td, V 1LLAUE Paint Color Approval and Agreement DATE: / OWNER'S AME: ADDRESS: 1 1 APPROVED: 0 ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: cl? CONTRACTOR & LICENSE (if applicable) COMPANY NAME: ********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** PHONE: 3 0 7 G 7' ©o v5 7 All Element on the site must be listed and indic ;d.. Walls 0 1 r) Fascia ' • Drip Cap/Drip Edge .€, A r Soffit `' - z Roof 1 t'I`'A Ce Yell cn Flower Bins w ro� n coot ro Shutters h Awnings"1 �► :1 </01 ki a ° ACC-) Chimney 0 0 y Doors and door jams 5 Garage Doors 3 Railings m Fences U2 PZI Decorative Metal All brick (simulated or regular) J'jYt Stucco Banding Any other stucco feat res �. Accessory LS %., t 1 til Li (N 6 Other S. 4. - e_ `o�C. k n- �� c � , 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 co truction and zoning. I authorize the above -named contractor, if applicable, to do e w ted. Furthermore , the paint colors will be as per the attached sa ^ 1- pl s ignat re of Owner Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION Building Official Date 4/23/01 1V111 .1V11 V YLLA( E Paint Color Approval and Agreement DATE: k.,^' L O OWNER'S NAME: •. (-e 4. PHONE3v o c) `f r ADDRESS: WI I- IU k lc- sr ************************ 1.********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: . **************************************************************** All Elements on the site must be listed and indicate the color to be painted.. Walls -ens 2 Fascia Drip Cap/Drip Edge it Soffit Roof -`e /` - Coo Flower Bins Shutters Awnings {rra Co 4 4,g T i ��V t' 1 ( itt Eau Chimney Doors and door jams Garage Doors Railings Fences Decorative Metal All brick (simulated or regular) Stucco Banding Any other stucco features Accessory Buildin s L maim ,v Other :( Sa 4 Cil�z 11 sa APPROVED: Building Official Date .94 1_ C american cheese 0 o. cn ro r t cn • 1-3 Z. - c • 3 • w ti 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 constru tion and zoning. I authorize the above -named contractor, if applicable, to do they iork,S4tey 'urthermore , the paint colors will be as per the attached Signature c f Owner Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 The Sunshine State -- LICENSE NUMBER L600- 521-58 -166 -0 LEROY ANTHONY LLERA 117 NE 9557 MIAMI SHORES, FL 33138-2708 BIRTH GATE SEX HOT. REST. ENDORSE. 050648 M 5.09 ISSUED EXPIRES DUPLICATE 051999 05.08-04 10.2242 X620210220391 of a motor Wide constitutes consent to any sobriety test required bylaw. • Miami Shores Village 10050 NE 2nd Avenue C\Phone: 305 - 795 -2204 Printed: 11/21/2002 t pplicant: LEROY o wner: LLERA JOB ADDRESS: 117 Contractor Local Phone: Parcel # 1132060132730 NE 95 Fees: FEE2002 -6641 FEE2002 -6642 FEE2002 -6643 Description Building Permit Application Fee Notary Fee CCF Total Fees: Amount $60.00 $5.00 $0.60 $65.60 Total Fees: $65.60 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 5/19/2003 Construction Value: $900.00 Work: EXTERIOR PAINTING AS PER AGREEMENT (OWNER BUILDER PERMIT) If there is no permit package accessible on the job -site for iosnectors to verify, there will be no inspections. fee is $50.00, which must be paid in advance before calling�� This Permit is granted to the contractor or builder named above to construe ordinances pertaining thereto and with the understanding that the work will be and approved by the proper municipal authorities. This Permit may be revoke '; authorization. A further condition upon which this permit is granted is the and ordinances and regulations pertaining to the work covered hereby whether sht by his agents, servants or employees. Signed: (INSPECTOR) In consideration of the issuance to me of this permit, I agree to perform th1. with the plans, drawings, statements or specifications submitted to the props myself, my agent, servants or employes. Signed: /4 " (Conti Building Permit Permit Number: BP2002 -2021 LLERA LEROY ST Contractor's Address: Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 E1/2 LOT 17 W1/2 LOT 19 & LOT 18 BLK 20 z�ffaM/f M .Gera 341 NW. 143rd St a:C 33168 Paytothe /� order of r � f?.tit, cP Kt m 13490 NW 7th Avenue, N. Miami, Florida 3378E For ': ?51: / RECYCI FO OAM Page 1 of 1 Re- inspection Date ir 577 :I G 1 2'L 63 127/670 03 $ (eG,(Q0 Dollars 8 • d 577 30S-478V—Y273P MIAMI SHORES VILLAGE Paint Color Approval and Agreement 019 S 893 DATE: - 00 OWNER'S NAME: go L��� PHONE: 36 S S 4 0 ADDRESS: \ 19 (J 9 S ************************ 1********** * * * * * * * * * * *. * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: UL. 9 S CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site mu t be listed and indicate the color to be painted: Walls Ve._\` Fascia Drip Cap/Drip Edge Soffit LJL I L Roof L Flower Bins Shutters Awnings Chimney Doors and door jams Garage Doors Railings Fences Decorative Metal Lht 1Yf,lvw All brick (simulated or regular) LLt Stucco Banding Any other stucco features Accessory'Buildings �c.«vw ` �1 -now Other Building Offici (0 a Date APPROVED: ar 11 /� / /Oa- P EI cn mellow yellow 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 co : ruction and zoning. I authorize the above -named contractor, if applicable, to do f e ostated. Furthermore , the paint colors will be as per the attached Sign.ture of Owner Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01