1285 NE 95 St (5)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
-
Date 3 4 Job Address /Ze S �� 1`x.3— J J Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant S $0�'? S Q,,� - a� - � Master Permit # •O 4 0 G
Owner's Address
Contracting Co. -0919 / G /47 / '-� � �/ ` 44ddress � 'f 4 9s
Qualifier' '/' 4i& .... SS# / Phon( Of 5`;C
State # Municipal # Competency # 0 /v / Ins. Co. 4'
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION A.74' u V_
Notary as to
My Commission E
FEES: PERMIT
�o er GC)
Square Ft. V Estimated Cost (value) ,Z� 8
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 compliance with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
a
r d/or Condo President C>
RADON
41- � ) / d/ t Building �2 t
( l
6 0/ -17
Phone
tary as to
My Conunission E
r r' co. - 4.Y..7 :L
p .. , zr "b co u A,o;a�w :
,
II s�•;','I o
:% ¢ cC735c97
1 A . - c : OM cua:Y! . -17120
C
C.C.F. " / )10 NOTARY': 0(/ BOND
APPROVED:
Zoning
Mechanical Plumbing Structural Engineer
Electrical
LZ
MIAMI SHORES V1LIA'GE
DATE: /Z 3 f8/ ...... • • • • •
OWNER' S N : .574.Sco ti S4 PHONE:
ADDRESS: /Z0" /Ut slv
•
************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *c1 , I * I * * ** * * *'s* ** **
ADDRESS OF SITE: /Z,IT Alt 9T S7
CONTRACTOR & LICENSE (if applicable) ea*/ /7 , nt-
COMPANY NAME: D/ 3/ PHONE!
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be,listed and indicate the color to be painted.
Walls f- 2/5r ( iiikr7
Fascia GOA.c. - f e n, W
Soffit a) , - 7 L e - Jn r/—(
Roof /v /if
Flower Bins AV#
Shutters Gu A /1e - re pi 6'
Awnings Ai/I/
Chimney Base Co/ z - / 'tea
Doors and door 'ams Co1> . /.; .: / � /
J
Garage Doors to% , My c -6 -0 J
Railings Go
Fences /l//ci
Decorative Metal fr/n
All brick (simulated or regular) ,r✓ /d
Stucco Banding W du
Any other stucco features
Accessory Buildings / v /#'
Other
samples.
.1� .
Signatur
* * * * * * **
Paint Color Approval and Agreement
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
f Owner
APPRO D
Building Official'
Date
/x.3(
ate
/0/
Signature of Contra or Date
• • ... • • • ...
• ......• ••••
• • • ...
• .
• • • • • • • •
• ...
• • .. • ..
• • .... ..
El
W
CO
c�
0
Dove Wing 960
misted green
z
3
******************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **