PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
10050 N.E. 2nd Avenue • Miami Shores, Florida 33138 • Phone: 305- 795 -2204 • Fax: 305
Date I f . 111 Job Address Tax Folio
Legal Description Historically Designated: Yes No
Owner /Lessee/Tenet K-e 5016 m G i ✓ Master Permit # 03 1/ J
/Owner's Address c/'73 NF q5 g1:" Phone 3,0c ` V 1 / — / g v I
c -e II: 1 /7- /t( 7- $-a• c j
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): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING
1 ( . 'WORK DESCRIPTION: . b rl Q 'r- f q
Square Ft. /sGimated Cost (value) (38/ 5O0
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 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 jurisdictiog. 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.
4. 11 . 4,1" .
a .4 1:
11 1� ° iPM sident
Commission DD150048
"4 1 6) ,„/ Expires November 15, 2006
My Commis
Date Signature of Contractor or Owner Builder Date
Date
0
C.C.F J/ 0 NOTARY I^ U C BOND
&' ( o
FEES: PERMIT RADON
APPROVED:
i t
Zoning a(2'd 17/
y
Mechanical Plumbing
RECEIVED
756- $7 0 9 003
Notary as to Contractor or Owner Builder Date
My Commission Expires
■•
TOTAL DUE
Electrical
Structural Engineer
MIAMI SHORES VILLAGE
Paint Colo ,Approval and Agreement
DATE: • ( � a 3
OWNER'S NAME: i t& e Uv S D (0 i i/1) PHONE: o S-
ADDRESS: - q73 5 ' j - •
********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: S 4 tm -‹
CONTRACTOR & LICENSE (if applicable) .5-e( F
COMPANY NAME: PHONE:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed a d indicate the color to be painted.
Walls t e►'z • Moo { -
Fascia (,dn
Drip Cap/Drip Edge
Soffit
Roof
Flower Bins
Shutters W (` f
Awnings
Chimney IA)
Doors and door jams 1.4J ; -t--c
Garage Doors k
Railings 't t 'm L(
Fences (alt i 1- t 4- - l
Decorative Metal (A) In f
All brick (simulated or regular)
Stucco Banding
Any other stucco features .--
Accessory Buildings --
Other
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
sam . les.
APPROVED:
Horizon Gray 2141 -50
,.
/ V/1• °3
.. .ail %LL
Signatur of Owner Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
WHEN PAINTING IS FINISHED,
/ CALL FOR FINAL INSPECTION
Building Official Date 4/23/01
Applicant: KENNETH
Owner: SALOMON
JOB ADDRESS: 973 NE 95
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: BP2003 -659
Printed: 4/25/2003
Contractor
Local Phone:
Parcel # 1132060143130
Fees: Description Amount
FEE2003 -2438 Building Permit Application Fee $60.00
FEE2003 -2439 CCF $1.80
FEE2003 -2440 Notary Fee $5.00
$66.80
Total Fees:
Total Fees: $66.80
Total Receipts: $0.00
Permit Status: Approved Permit Expiration: 10/21/2003 Construction Value: $2,500.00
Work: exterior pai • as pggagreement
f / 2 � C
(INSPECTO
Signed:
In consideration of the issuance to me of this permit, I agree to perform the wort
conformity with the plans, drawings, statements or specifications submitted to the
done by either myself, my agent, servants or employes.
Signed: (Contractor
Building Permit
Contractor's Address:
Legal Description: 5-6 53 42 MIAMI SHORES SEC 3 PB 10 -37 LOTS 24 & 25 BLK 76 LOT SIZE
SALOMON
KENNETH
ST
aN
:;a ril SHVTIOG
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