PAINT• 1
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
for the approval of the detailed statement of the plans and specificatio is herewith submitted for the building or other structure herein
lade in compliance and conformity with the Building Ordinance of Mia ni Shores Village, Florida, and all provisions of the Laws of the
of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether
of approved plans and specifications must be kept at building during progress of the work.
Hasa- L Date + �- }. fr
19 I
Owner's Name and Address \� Rey �R� SO 1 U to k _r o. 1.c`• lc
Registered Architect and/or Engineer C 1 'L/L
Name and address of licensed contractor r L
Location and legal description of lot to be bu t3
on: / / .'1�0(, /4 '?O 4 �
Lot Block Subdivision t C! ' 1°1 IC0.11 (3,co, C
Street and Number where work is to be done 0 - /,7.-k-`‘
t
State work to be done and purpose of building (by floors). state exterior colors (submit samples)
and for no other purpose.
New Building Remodeling Addition Rvairs :ASV No. of Stories t U.: Cs
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements S t3 C7 C Amount of Permit i
Zone cubage required Plan Cubage N
j,
Distance to nest nearest building �? - T ��+ Siza of Building Lc X (V � X. 1 tJ `1
Maximum live load to be borne by each floor
I hereby submit all plans and specifications for said building. All notices with reference to the built ing and its construction may be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob:igatons as an employer of Labor under the Florida 1 orkmen's
Compensation Act, being Section 5966, Compiled General Laws of Florida. Permanent Supplement. and has complied with the provisions thereof, and will require similar
compliance from all contractors or sub - contractors employed by him in the work to be performed under tl.is. permit; and will post or cause to be posted for inspection
on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed
under this permit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA
COUNTY OF DADE.
}SS.
Before me. the undersigned authority. a notary public. duly authorized to administer oaths and take ictnowledgments, personally appeared
to me well known.
and who, being by me first duly sworn. upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application. and that he did sign the same. and that all facts therein by him stated are true.
Permit No. 7D ? ( Date 6 / 0 li Read. Sworn to and Subscribed before me.
Disapproved Date
Notary Public. State of Florida
(Signed)
Building Inspector My Commission Expi -es
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved
Date
NOTE: A charge of 525.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board.
A re- inspection fee of $25.00 will be charged when such re- inspection is made necessary by improper not ice for inspection or faulty materials and/or workmanship.
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building
or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores
Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regula-
tions of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans
and specifications must be kept at building during progress of the work.
Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot
Street and Number where work is to be done
State work to be done and purpose of buildin
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
New Building_ _________ Remodeling —__ Addition_
To be constructed of_— __ —____ –_ Kind of fouadation
Estimated Total cost of improvements $
Zone cubage required
Distance to next nearest building
Maximum live load to be borne by each floor
R. .' r.
Permit No Date
Disapproved ___________ Date !
(Signed)
MIAMI SHORES VILLAGE
Block_ �_ —_ Subdivision
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
The undersigned applicant for this building permit does hereby certify that he under. tands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement.
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on v or. to •e performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
and who, being by me first duly sworn, upon oath eposes and says that be is the
of the above described construction, that he has c9*e fplly read the foregoing application, and that he did sign the same, and that all facts
therein by him stated a
,.__hoof Covering_
1 Amount of Permit $ 1
Plan Cubage
Size of Building Lo
Building Inspector My Commission Expires
Due-- — -- — - 19
1' o .. Street__
Re pairs
Read, Sworn to and Subscribed before me.
— _and no other purpose.
No. • f Stories__________
to me well known,
Notar' Public, State of Florida
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved___ Date Disapproved
Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and/or workmanship.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
8 1z
Date ob Address / l h c /
1 ,Tax Folio
Legal Description Historically Desig sated: Yes No V�
Master Permit #
Owner/Lessee / Tenant ,C 0 -2 5a w S
Owner's Address / 4V 9
Contracting Co. C tom)
Address
P h o n e 7 8 3 c
Qualifier SS# Phone
State # Municipal # Competency # _ Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANIC'AL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
A. S Q
- P-r tmeN vim [ (-1 1 TE
Square Ft. Estimated Cost (value)
Signature of owner and/or Condo President Date
My Commission Expires: My Commission Expires:
FR®k[T Oaog- +.BOORS Ofu r &RCF 1
3 �C)
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.
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.
_C3 i
Signature of Cortractor or Owner - Builder
/„,''t7
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner - Builder 4 ate
FEES: PERMIT s RADON C.C.F. fa NOTARY v BOND
TOTAL DUE -2-/IS -
APPROVED:
b.
Zoning Building / 1 \ N ` ` 1 Electrical
Mechanical Plumbing Engineering
ELECTRICAL
TYPE. QTY. TYPE
QTY. TYPE
QTY.
TYPE. QTY.
Minimum Fee
Generator
Dryer
Refrigeration, Tons
Outlet, Appliance
A/C Central, Tons
Service Repair
Cooling Tower
A/C Central 1 -3 Ton
Heating Strips, each
Fan
Vent Hood, Cost
Outlet, Wall
A/C Wall/Win. Tons
Service, Temporary
Dryer Vents, Number of
A/C Central 4 -7 Ton
Paint Booth
Fire Pump
Ventilation, Cost
Outlet, Switch
Air Handler, Tons
Signs
Ductwork, Cost of
A/C Central 8 -15 Ton
Piping, Flamma )1e Liquid
Fixture - Fluorescent
Periodic Inspections
Oven
Barbecue
Space Heater (kw)
Fire Sprinkler System
A/C Central 16-20 Ton
Process/Pressurt Piping
Fixture Light
Parking Lot Li;;hts
Bath Fan - Vented, #
Spas/Hot Tubs
Fireplaces, Number of
A/C Central 20+ Ton
Pressure Vessel
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Tip
Swim Pool, Residential
Chiller
Generators, etc.
Receptacles
Switchboards
Clear Violations
Heat Recovery
Refrigerator, C )rnm. (p/PH)
Disposal
Temp Serv., Construction
Interceptor
Laundry Tray
Compactor
Drainfield, 4" Tile/Res.
Low -volt, Burglar
Lavatory
Refrigerator, Domestic
Septic Tank
Temp for Test - 30 days
Water Heater New
Deep Freezer
Drains, Area
Low -volt, Fire
Meter Set (Gas)
Renew - Temp t ervice
Sewer Connection.
Water Re -pipe
Demolition
Drains, Floor '
Low -volt, Intercom/Teleph.
Minimum Fee
Repair Circuits
Shower
Water Service
Dishwasher
Drains, French
Low -volt, Television
Miscellaneous Equipment
Service, Numbe r of Amps
Sink
Well, Supply
MECHANICAL
TYPE QTY. TYPE QTY. TYPE QTY. 'TYPE Q1 Y.
Minimum Fee
'I'YI'E
Drains, Roof
Condensate Drain
TYPE
Miscellaneous Fi rture
Generator
Tl'1'E
Soakage Pit
Refrigeration, Tons
Bath Tub
A/C Central, Tons
Drinking Fountain
Cooling Tower
Miscellaneous Repairs
Heating Strips, each
Solar Water Heater
Vent Hood, Cost
Bidet
A/C Wall/Win. Tons
Filter Replace
Dryer Vents, Number of
Pool Piping
Paint Booth
Sprinkler Repair
Ventilation, Cost
Cap - Fixture
Air Handler, Tons
Fountain
Ductwork, Cost of
Pump and Abandon
Piping, Flamma )1e Liquid
Sprinkler System
Periodic Inspections
Cap - Water
Barbecue
Gas - Appliance
Fire Sprinkler System
Pump, Domestic
Process/Pressurt Piping
Supply, AC Well
Cap - Sewer
Bath Fan - Vented, #
Gas - Natural
Fireplaces, Number of
Pump, Fire Stand
Pressure Vessel
Temporary Toilet
Catch Basin
PLUMBING
TYPE
A/C Condensate
QTY.
'I'YI'E
Drains, Roof
QTY.
TYPE
Miscellaneous Fi rture
QTY.
Tl'1'E
Soakage Pit
QTY.
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circuk to
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Indirect Wastes
Pump, Sump
Relay Repair
Roof Inlet
Septic Connection
Utility - Water
Vacuum Pump
Water Closet
Water Heater
Dishwasher
Disposal
Interceptor
Laundry Tray
Domestic Well
Drainfield, 4" Tile/Res.
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection.
Water Re -pipe
Drains, Floor '
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
Page 3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed anc quantity(ies) in the space provided below.
RECEIVED AND REVIEWED BY: DATE:
SECTION
BY
/�jJ4 ?— 9
DA E
3/4/c
V-�o°ning
t)Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
1
.3 2' 2
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
LI FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
LI CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.)
Inspector State Educational Fund
State DCA (Radon)
Code Enforcement Fine
Zoning Review
ISSUING OFFICIAL
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERNIIT FEES
$ (0.005 /sq.ft.)
(sq.ft. = x/1000
x 0.60)
(0.01 /sq.ft.)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $
\d) Ii EV1EWED AND PREPARED BY:
� C
,�
DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2N AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
N � I, W !"Y� R () F)61..„6
2 -b AI E GI 4 ...k S 4--
Address
3v — 1 s —0r2eD
Home Telephone
Business Telephone- 4. 02. to
Alteration E: cterior
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration E: cterior
Repair
Alteration Ir terior
Demolish
Relocation o:' Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'I Detachment
Other
INSTRUCTIONS - The following steps must be taken to obtain a permit front the Miami Shores Village:
Step 1.
Step 2. Submit the completed application with all necessary documents to the Building, Pk naing and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
APPLICATION
Job Address:
Complete the attached permit application which must be signed by the property own ar and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted
along with this permit application.
l t to ,v. O 44 _ Lee+ H (L , 1 L 33 13?'
■( Description of Work /A
Folio Number
Lot Block
Subdivision PB
Current Use of Property
Proposed Use of Property
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Address Apt. City State Zip
Value of Work
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
PG Zoning
Square Feet Units Floors
Tax Assessed/Appraised Va ue
Flood Zone
Master Permit No.
Subsidiary Permit No. jP- 200 5 9 cf-
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
Address
Telephone
Qualifier Name
PERMIT APPLICATION
rJ r ZoOF "172) , 34 l.ls E
tofu 1
Linear Feet
Bldg Value
Base Floor Elev.
Fax
Page 2
IMPORTANT NOTICES
1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work tc my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished 'floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1s' Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
ST E OF FLORIDA, COUNTY OF MIAMI DARE STATE OF FLORIDA, COUNTY OF MIAMI -DADE
K ignature of Owner
- 51-/✓1/ h 7
K fr int Name Print Name
w ■rn to and subscribed before me this
I•,
A► `!
` ignature o No
Na P 'e ANGELA :''1 3CA,EFI
SEAL: . .(r i0 co e .on :u::'.a;. SEAL:
qp - 7d5y 9j MY Co;A71 tC�� e:.7T?s F OF f:.''.1).(''1.
NOV. . 55
Signature of Contractor / Qualifier
Sworn to and subscribed before me this day of
Signature of Notary Public - State of Florida
PERMIT APPLICATION
Personally known OR, Produced Identificationl / Personally known OR, Produced Identification
Type of Identification Produced: / " N,,C Y3'? C (3s 7(� ^ `a". D Type of Identification Produced:
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305- 795 -2204 Permit Number: BP2002 -594
Printed: 3/21/2002
Applicant: HELEN COFIELD
Owner: COFIELD HELEN
Contractor Address:
Local Phone: Cellular:
D.....,.1
41 1 1 •27r1G2r11 A '2po1n
1
as V61 Tr 1 1JLV VV 1 '7J JV
Job Address: 1286 NE 96 ST
Description Amount
Building Permit Application Fe*60.00
Fees:
FEE2002 -1657
FEE2002 -1658 CCF $1.20
FEE2002 -1659 Notary Fee $5.00
Total Fees: $66.20
Permit Status: Approved Permit Expiration: 9/17/2002
Building Permit
Legal Description: 5 -6 53 42 MIAMI SHORES SEC 3 PB 10-37 LOT v BLK 04 LOT SIZE
Work: PAINT ROOF, TRIM, HOUSE AS PER AGREEMENT (OWNER BUILDER PERMIT)
This Permit is granted to the contractor or builder named above to construct the I
ordinances pertaining thereto and with the understanding that the work will be perfo
and approved by the proper municipal authorities. This Permit may be revoked at e
authorization. A further condition upon which this permit is granted is the understar
ordinances and regulations pertaining to the work covered hereby whether shown o
by his agents, servants or employees.
Signed: (INSPECTOR)
In consideration of the issuance to me of this permit, 1 agree to perform the work
with the plans, drawings, statements or specifications submitted to the proper authc
myself, my agent, servants or employes.
Signed: (Contractor or
Page 1 of 1
Total Fees: $66.20
Total Receipts: $0.00
Construction Value:
If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
fee is $50.00, which must be paid in advance before calling for another inspection.
SANDRA M. COFIELD
670 N.E. 53RD ST.
MIAMI, FL 33137
Pay to the
order
$2,000.00
Dat
Bankof merica.
ieax41 fa/144?-
71: 00350957 L46011' L405
ACH R/T 003100277 / � ,
For
1:06 3 L00 2
1405
17/631 FL
cZe 995
I $ t ,
)s zfnples.
MIAMI SHORES VILLAGE Paint Color Approval and agreement
0 DATE: I�� 2-
OWNER'S AME: 5117 /'1" r C F /�D PHONE: 3 a� 74 0 • Za
ADDRESS : /4(v E r'I (o 0 1 - CI' /if FL 7.? ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: / 2S'b �` 6-' 94 CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
**************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the ite must be listedand indic the color to be painted.
Walls �- (ti ' 5 ' old) S"a y y ►� /e
Fascia c/ (/.J/� rtE
Drip Cap/Drip Edge c/'( /,)hftE) Soffit 1./ ( tai ) '\ ° � Roof c/ (c,/hitc) �
Flower Bins Lt A r f 2 . t a+ �'�
Shutters e/ (rte j.,, ) °° 1� re L
Awnings j
hriz
Chimney L/-4 (c)bS, /d) �e Doors and door jams
Garage Doors
Railings
Fences
Decorative Metal
All brick (simulated or regular)
Stucco Banding
Any other stucco features
Accessory Buildings
Other
( &4t'
GG132 WorchesterGold
721oF, � '7T , F 5c/ - ALz. � d #i jc)F 6779 riW 1-jvOSE 1t 7.v ZW frt//►/ i t u) wTr
OWNER'S AFFIDAVIT: I certify that all the forego:ng 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
Ov"-",tot- 77/ , 3/10z-
gnature of Owne Date Signature of Contractor Date
************************************ * * * * * * *:: * * * * * * * * * * * * * * * * * * * * **
APPROVED: WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
Building Official Date
4/23/01
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
i•
DATE: -3/2 0
D Z- 1
OWNER'S N S4,0 0/Q p �, 6y- /E'7,- +PHONE:.3., 75 - o_5
ADDRESS: / ' ? 7, = fi Jr .77,42 ., ,f404.1i-5 * * * 3* /3
:k
* * * * * * * * * * * * * * * * * * * * * ** ** * * * * * * * * * * * * * * * ** * * * * * * * * * * **
ADDRESS OF SITE: /7,,&' - £ 2( �r
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
********************************** * * * * * * * **:k* * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls ,c,V /3 SSA h
Fascia 4
rip Cap/Drip Edge 1 4
Soffit y/j /�l
Roof f/ / �
Flower Bins gig/ /e"
Shutters Gf//f�% 7
Awnings -----
Chimney S'c( %,orSvrr -)
Doors and door jams D
Garage Doors
Railings
Fences
Decorative Metal
All brick (simulated or regular) u/ / //j
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
APPROVED:
5 /'Z° / ?°°
Signature of Contractor Date
Signature of Owner / Date
* * * * * * * * * * * * * * * ** ****************** * * * * * * *:c * * * * * * * * * * * * * * * * * * * * **
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
3/d
Building Official Date 4/23/01
SCLIE - -51
bI osio:T.
_3l
,,