PAINTr'
BUILDING
PERMIT APPLICATION
FBC 2001
iami Shores Village
ing Department
Job Address (where the work is being done) 'tO . t1E_ 0 14 3k
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO
Permit No. SPZ -- ) J22
Master Permit No.
Permit Type (circle): (fading) Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) c14.
er) 11 .L CXOI Phone #
Owner's Address 0 410 '14 s
Cit State Zip
Tenant/Lessee Name Phone #
Zip
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
• Contractor's Company Name , / /V/ 4 Phone # 3 , 51
Contractor's Address / � c G l��/ 6 0 1�� --�
City He /I xl State rL • Zip 33 012,
Qualifier
Architect/Engineer's Name (if applicable) - Phone #
Architect/Engineer's Address
City State Zip
• . $ Value of Work For this Permit 1 I � W • Square Footage Of Work:
Number of: Bays Stories Families Bedrooms Baths
Type of Work: ❑Addition n Alteration ❑New ❑ Repair/Replace ❑ Demolition
Describe Work: % n l e�E y mr s-e_.
****************************Fees****************************** rl
County Escrow Fee $ 1- 2- 0 . Permit Fee $ CO CJ 0 Notary $ S 0 0
Education/Training Fee $ Tech $ Scanning $ Radon $
Code Enforcement $ Bond $ Struct. $
Minus Plans Check Fee $ Total Fee Now Due $ (a (, , o . () • (Continued on opposite side)
PC CA- i n of I QC QO5
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
. Signature ,
Owner or Agent
The foregoing instrument was at Wald()
e
h(4 ed before me this 1
day of) ± �-�`( 1 ald() rJ
who is personally known to me or who has produced 1Q
NOTAR
Sign:
Print:
chc7/7ro3
UBLI
As identification
APPLICATION APPROVED BY:
•
State
Zip
d"siid tbip
c ommissi on
o _ x mission #p023
p res: Jul 13, 2007
Bonded Th
Atlantic Bonding CPO., Inc.
Signature . y(....G C((7 0 4C%„„..t a
Contractor
ent was acknow - dged before me 's 1/
2003 by 11 •� 1
who is persona ly known to me or who has produced
as identification and who did take an oath.
e fore • oing in
ay of
l
l/ l /
Y PUB I n Ac-0('D
Sign: ) 11 A�0�
Print: Li/ / ; Pt NI Cf , LoSt
• 'r
My Commission Expires: My Commission Expires: OFFICIAL NOTARY SEAL
******************* s********************************* * * * ** ** **** * ** ** ** * ** ** * * * * * * ** LILLIAND LOSA
(Certificate of Competency Holder) N COMMISSION ��C970946
MY COMMISSION EXP. OCT. 22,2004
State Certificate or Registration No. Certificate of Competency No.
AUG 1 3 2003 Plans Examiner
Engineer
Zoning
1
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE: l /c) 3
OWNER'S N PHONE:
ADDRESS:
*********************************** * * * *** * * * * * * * * * * * * ** *. * ** * * ** **
ADDRESS OF SITE: L 1/0 4J
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls (beige
Fascia lohlle
Drip Cap/Drip Edge Wlnt'{'e
Soffit
Roof (SUlnt Ve..
Flower Bins (52t ie
Shutters N 1 Pi
Awnings
Li) r -Q
Chimney ( Ohl
Doors and door jams LI 1 Pt.
Garage Doors 1 _
Railings 1J l Pr
Fences vq-
Decorative Metal
All brick (simulated or regular)
Stucco Banding
Any other stucco features
Accessory Buildings
Other
APPROVED:
Building Official
/.2
Date
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
samples.
Signature of Owner Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01
SW 6100
Practical Beige
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: BP2003 -1322
Printed: 8/13/2003
Applicant: ABELARDO
Owner: DOCAL
JOB ADDRESS: 410 NE 94
Contractor
Local Phone:
Parcel # 1132060140360
Building Permit
DOCAL
ABELARDO
ST
Contractor's Address:
Page 1 of 1
Legal Description: MIAMI SHORES SEC 2 PB 10 -37 LOTS 11 & 12 BLK 51 LOT SIZE 100.000 X
Fees: Description Amount
FEE2003 -4977 Building Fee $60.00
FEE2003 -4978 CCF $1.20
FEE2003 -4979 Notary Fee $5.00
Total Fees: $66.20
Total Fees: $66.20
Total Receipts: $0.00 ��.
�
Permit Status: APPROVED Permit Expiration: 2/8/2004 Construction Value: $1,200.00
Work: PAINT EXTERIOR OF HOUSE AS AGREEDED
Signed: (INSPECTOR)
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict
conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY: