1220 NE 94 St (21)Qualifier
State
WORK DESCRIPTION r e6k1 tJ ■
FEES: PERMIT
APPROVED:
Zoning di
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address 1Q1l V\(` 9'4 S Tax Folio
Date
Legal Description
Owner/Lessee / Tenant r r f. cAa \
Owner's Address IC 1g f ,(44-
Contracting Co. a 1 .�?0 P t 1- i OP 9
U ) c—c-co-fa_ -\)(Nt
Municipal #
Architect/Engineer �! Address
Bonding Company Address
RADON
Building
Historically Designated: Yes No ✓
Phone
Cam 11 b
Competency #0055C1�sfl ? Ins. Co. RIsr\ ci eN?
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN 1
Square Ft. Estimated Cost (value)
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAI URE 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.
��� l�,r,�,. &3 ' mi
_ cr
• 5cpirrs • ,ES: March 24, 2002
-1, to :*. Bonded {i :;;i i - p
ub I::. .! ;denvriters
AVIT: I certify that all the foregoing information is accurate and that all ork ll be done in com liance with all applicable laws regulating
e ning. Furthermore, I authorize the above -named contractor to do tie •rk s :ed.
S
No
My Co
C.C.F. ,� 7) NOTARY O BOND
Phone (,o(o It
Address t 0 ( S CA/ f rT,Ltip
Electrical
I1 - — OCT? —
Master Permit # 63f
P- 1 de
TOTAL
DUE
D. to
Mechanical Plumbing Structural Engineer
1
MIAMI SHORES VILLAGF W C Ys
DATE: J
OWNER'S N • ME:
ADDRESS: M
APPROVED:
Paint Color Approval and Agreement
Signature of Owner
** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Building Official
Date
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE:
CONTRACTOR & LIC SE (if applicable)
COMPANY NAME: A CSI` 0 (P 1 PHONE: (30, '7 96, SI L O
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted
Walls b Sp-fzr 0.44c. rus
Fascia `Pk)
Drip Cap/Drip Edge
Soffit ,
Roof tJ 1 R
Flower Bins�j
Shutters
Awnings 1J 1 i
Chimney �)
Doors and door jams ' -l v I wry ( OM-
Garage Doors oi 1 A
Railings r .! 1
Fences
Decorative Metal c
All brick (simulated or regular)
Stucco Banding
Any other stucco features
Accessory Buildings
Other
DESERT CACTUS
PUMICE
31 1-3(MT)
370
`` -4(WW)
wi
0
0
x
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 contra tor, if applicable, to
do the work stated. Furthermore , the paint colo is wil be . d - r th att c ►)- d
i samples. � ti � � � s
ontrac Oa
nature o f
C
* * * * * * * * * **
* * * * * * * * **
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01
r
dopy
r� ,e��vlah�ctSe .
• ' MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE:
OWNER'S 'A E: t fr o PHONE: ins— 7/ - 4 1
ADDRESS: ,1 ; • yam'
* ,, * rxhcx ; c ** ** ******* *** *** * **** *** *** ***
ADDRESS OF SITE:
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls ,k'- Ok 7sc
Fascia oi e_
Drip Cap/Drip Edge
Soffit 0
Roof ,4) /A-
Flower Bins i v/ yk-
Shutters
Awnings
Chimney
Other
APPROVED:
AA A-
( IPr
kJ IA
Doors and door jams
rrrtu
/UM-
Garage Doors
Railings /U IA-
Fences /
Decorative Metal 1v /A-
All brick (simulated or regular)
Stucco Banding Iv/
Any other stucco features
Accessory Buildings
Building Official Date
AAA-
k)/A
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
d• the or t, • ted. Furthermore , the pair colors will by s e t e tached
s: ple
lgnature of 1' _ S ate ature of Co . Its ate
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
p \. 51r , ■ CE
Pz/v
PHO ' 0
7
S1
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01
f
or
0 b�
u
��y
6 66 00_