501 NE 96 St (4)Date Job Address5() W 6 Tax Folio 3 *-) b 0 I -SS 7 )
Legal Description h Alp I I at
Owner/Lessee / Tenant RcQ) }') m Pte f
Owner's Address 50) 1 , E 4 b St 1 q mi) A v re c / F 1,
Contracting Co. Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION Pfr SS L{ re C )e q r •r Pa'int e ct S I ®�
Square Ft. 00
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.
OWNERS APPIDAVTT: 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.
APPROVED:
Zoning
Mechanical
My Commission Expires:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
and/or Condo President Date
60 -q •,1) & e J j ,/ ) J Il )D0
as t .' r d/or Condor rl
f=
O =ICL4L 3 OTAFIY ' o I
♦PR PUe( AN+GES A CT BECKER i
6 ( � C; oae.:1a ,Vox RtAISE It
▪ :. Q CC78669
F OF f1 y__.
FEES: PERMIT 6 0, OD RADON C.C.F.
Historically Designated: Yes No
Master Permit # 1,00L.(k
Estimated Cost (value) 1 , 0 ® n
Signature of Contractor or Owner- Builder
tor or
D L D - 0 4 a -'/ 1 a.---b
0
otary a" to Con
My Commission Expires:
Building
Plumbing
Phone 305 - q,S I - s ck91
30 - 3Q11 s
W VL
NOTARY ,0 8 BOND f
TOTAL DUE (cs 5p 6 2)
Electrical
O ,PR. U ▪ r B AadGELs2 i t 9 LI.F.7
•
Ti 9 Tr -4 CC786 ::
9 " is Y C(k?`.MISS'o;' a;: .
' O F F\. O 0301,. ' Zt,r ..
Date
Structural Engineer
- MIAMI SHORES VILLAGE
DATE: l ! $�o
OWNER'S N c- /?a k f .ss PHONE: ? ° =737 -5 z
ADDRESS:5 / `g(f1.\ /t4 r 3 .?/ 3 �
********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: 50 / T6 S - r-e -e-- /4, a S�i �� s
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
VU I
Walls
Fascia -
Soffit Vl) ek
Roof l� ��e--
Flower Bins () 4
Shutters A/ 4
Awnings /V
Chimney
Doors and door jams R-ea-- C " 12 - - f 3 '
Garage Doors ( - - '
Railings /VP"
Fences i4-
Decorative Metal X/ 4
All brick (simulated or regular)
Stucco Banding /4 4
Any other stucco features A/4 ( it.,
Accessory Buildings //*
Other Win '/ u n-rela ig
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
. es.
Sign. ture of Owner a Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED:
Paint Color Approval and Agreement
Building Official Date
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION