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MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE: /OS*
OWNER'S NAME: ,ef N7Aitnedv) PHONE: II:" 7.5' 7,0
ADDRESS: 4/ /Y.S. 95 -- /yr •
ADDRESS OF SITE:
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
All Elements on the site must be listed and indicate the color to be
Walls�.� --1 Aeli I, / lId/
Fascia ,4
AG-
Soffit pc — 1
Roof /1/
Flower Bins X99
Shutters H C
Awnings !1//41
Chimney pyfoses#7 09;C, —
Doors and door jams I W 77
Garage Doors Agilk44 /C —
Railings 414
Fences _
Decorative Metal Gl/,�i� `7
All brick (simulated or regular) A/
Stucco Banding C
Any other stucco features
Accessory Buildings
Other Atetifea
OWNER'S AFFIDAVIT: I certify that all the foregoing informatior
and that all work will be done in compliance with all applicable laws
construction and zoning. I authorize the above -named contractor, if
do the work stated. Furthermore , the paint colors will be as per the a
mples.
APPROVED:
Building Official
II ti
ate
BENJAMIN MOORE@ u
COLORPREVIEW° HC
0
Si of Owner Date Signature of Contractor Date
* * * ** ***************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
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0
0
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PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
/ /�� 2
lI � 1
Date Job Address 7 7 JU / C -S/ • Tax Folio ) / - 0 6 - 0 ) V-6 (o 0
Legal Description Historically Designated: Yes No X
Owner/Lessee / Tenant 3 ( _f e j a —, Master Permit # i t? L
Owner's Address 4 3 V /U 5fl Phone 757- `/•O Si 3
Contracting Co. c--) W ('£ • OUfner Address.
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor A /V -AMA Q
FEES: PERMIT - i 70 RADON
APPROVED:
Zoning Building
Mechanical
Address
Permit Type (circle one): ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION ♦ _ni ' Arm / - � �usPi Ct,if1 c. J C - fop ' / L
o �p_ re � � -mil
tr ti M kckiremFarAll ! rks i ei g -e-Sh2u -CG'S j `�} t�,G ��,n
r nom. �
1s 0 Square Ft. 3, Op O Estimated Cost (value) y� 0
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 perfonned 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
gnature of
i .0,40/
J
• • 1 c .r or Owner - Builder
Electrical
Notary as to Owner and/or Condo President Date Notary as to Coi4tfactor or Owner - Builder Date
My Commission Expires: My Commission Expires:
f 6 RY PO
gN CIAL 0 A p COMMISSION NUMBER
a 4` IiP l Q CC797277
v, VII' r.0r?"ISSION BOND EXPIRES
;F C. 17,2002
'
TOTAL DUE 51 JO
Date
6- ? g -do
Plumbing Structural Engineer