PAINT«CEIIVE®
PERMIT APPLICATION FOR MIAMI SHORES VILLA E jjL 8 2003
10050 N.E. 2nd Avenue • Miami Shores, Florida 33138 • Phone: 305- 795 -2204 • Fax: 05- 756 -8972
Date 1'3:03 b Address 1 155 NE 6 155 •7RCETax Folio
/
Legal Description Historically Designated: Yes No l
Square Ft.
•
. K �J
wner /Lessee/Tenet OEIU R FQ ZDOI A 1U Master Permit # OP DiCX 3 i' 11
�� Q ho V►+e- ln?A r�
X Owner'sAddress 955 NE. '5 Sr. P1 OS"'�'JF- 1 l 3os -8877
Contracting Co. Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY,
THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE
BEFORE CALLING FOR ANOTHER INSPECTION.
Permit Type (circle one):
ORK DESCRIPTION: pa.l tf1- e_yfe rinr of /10 to ,
a i&cL S.c.a..t Ot.r'i vI,u.)4
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF CO CEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN
YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR ANY ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that
all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required
for all disciplines.
OWNERS AFFIDAVIT: 1 certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Furthermore, I authorize the above named contractor to do the work stated.
n.''re of owner - der- ConclerPresithdent
j,# F1o35- `f3 ''7 -70S7- O
otary as
My Comm
P1f2E5 —CS
wner an
sion Expir
d®n$dssldegke
My Commission DD150048
o f Expires November 15, 2008
RADON
ELECTRICAL PLUMBING MECHANICAL ROOFING
—
Date
Date
C.C.F
ated .st (value) 300 0
FEES: PERMIT
APPROVED: JUL g
Zoning Building li t JU 1 4 1003 Electrical
Mechanical Plumbing Structural Engineer
Signature of Contractor or Owner Builder Date
Notary as to Contractor or Owner Builder Date
My Commission Expires
NOTARY 5,00 BOND
TOTAL DUE G, P
MIAMI SHORES VILLAGE
Paint Color Approval at :: Agreex tent
DATE: - '1,._Y S a 0o3
OWNER'S NAME: _TOEV FiizteDmAru PHONE: 306 hoyne.
ADDRESS: 6 155 ALE 6 15 Sr 30s -7SY -8877 WOr
********* ************************** * *:-4 * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: 9'55 /VE q 5' ST:
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
**** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *k 1 * * * * * * * * * * * * *** * * * * * * * * **
Garage All Elements on the site must be listed and indicate
Wall h-ogizo& cpit�' 1Al i -So
Fascia mTA�t(L otiyi - (00
Drip Cap/Drip Edge PLASH t 06- is ALREADY wtf ire
k
Soffit iJlu.m a l't I -k \ .00f ROOF is N eo
\ Flo', r Bins conicizere p44 n +s N n.&eaL. CD1Ct - re
} Sh.._ ers pEWTEIZ (see SAvnpLE�
Awnings IVA.
Chimney ctfhmNe"e t s ALREADY Wt+rrE
Doors and door jams n - Donis N.A. / ft DonerngHoc�aY /Doo>z T s
Garage Doors 5A-mE coLO(e- As wALLs
k:1
Fences N .fl ings /AL A.
Fen N- A•
i gnature of Owner
APPROVED:
tL colo
1B
°mow
(4) LA. BE Mme
Deg
All
Stucco Decorative Metal Pew - re le_ CscE ee.�
All brick (simulated or regular) W41- A P I - f- te L.uill ialad
S
tucco BandinggeoWND FR_o!Jr DoolL ciAgAr b #AeoA-lrw,NDOWJ — tu}Itr
y other stucco features
Co n c. .z te. st� - ne w �- la.�(�, a, Ax u.+,Rl erK . -
Accessory Buildings 1 st � / +Wilt i
Other ' SEAL De Wekmy
C 1i NER'S AFFIDAVIT: I certify that all the foregoing information 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.
1-F -03
Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
7 / ? s
Building Official Date 4/23/01
2141 -60
4.
0
2141 -50
5J
Apply Sealer
Driveway Condition
Product
Average Poor No Inclines Inclines High Traffic
Oro -Gel
Race -Way
Drive -Kote
BEST
BETTER
GOOD
BEST
BETTER
BEST BETTER BEST
BETTER
GOO
BEST BETTER
GOOD
GOOD
• Renews Blacktop Surfa
• Premium Filler & Sealer
• 6x Polymer Concentration
• Fast, Clean & E -Z to Apply,
• Your Best Driveway Choice
s
• Lasts 3x longer than
standard filler
• Easy pour spout
Blacktop
Drive Patch
• Fast drying, extra durable
• Repairs holes and cracks up
to 3" deep
• Resists gas, oil & chemical
deterioration
RePave
Pot Hole Patch
• Repairs holes 4" or larger
• Stone & asphalt mix
• Tamp into place
What Sealer Is Best
For Your Driveway?
• Renews Blacktop Surfaces
• Premiu` Filler & Sealer
• 4x Poly r Concentrati
r Better rfv: • : ■ Choice
tazaQer
��RIYE - NOTE
• Renews Blacktop Surfaces
• Filler & Sealer
• 3x Polymer Concentration
D
Type Insp'n
Permit No.
Nafie�
Address
Company
Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
9ssfy).
-137y