PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 9 a � m ° Job Address /1 4'O NE- 9Bi St Tax Folio
Legal Description 4fot Historically Designated: Yes No
Owner/Lessee / Tenant y d• (' n GL-/ �- 1 Master Permit # 7 S ' 0
Owner's Address Phone ) - Y" ` .5-.Q
Contracting Cok Oyjp -140d 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 ROOFING PAVING FENCE SIGN
WORK DESCRIPTION ? r' 0/K17/ i'W— l Hi 1E- Gcx -64Z-)
Square Ft. Estimated Cost (value){ I 0 DO ,
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 w.rk s
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date No . as to Contra.. , Y SEA
My Commission Expires: Commission Ex fires: GLADYS J VILLAR
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC714103
MY COMMISSION EXP. MAR. 1,2002
c FEES: 0 o --- BOND PERMIT RADON C.C.F. NOTARY
Date
c
TOTAL DUE
APPROVED:
Zoning Building Electrical
Mechanical Plumbing Structural Engineer
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE: q(G
OWNER'S NAME: eat / ten / PHONE: 30' j -
ADDRESS: I ( 'fQ [ Aft S -
********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: , ( L/D (Lta. 79f/ cST
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: 0 W 1 e-- PHONE:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All lements on the site must be listed and indicate the color to be painted.
Walls
ascia
Soffit
Roof
Flower Bins
Shutters
Awnings
Chimney
Doors and door jams
Garage Doors
Railings
Fences
Decorative Metal
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
Signature of Owner Date Signature of Contractor Date
***************** ******************************************************
Building Official
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE /
Date 3 - Job Address / ((/ / / e te (� Tax Folio
Legal Description Historically Designated: Yes No V
r^
Owner/Lessee / Tenant OoS�/>7i4�2 / � / OE Master Permit # 4C
Owner's Address o?6, 0 , V /0/ Phone 7 /
Contracting Co. C /A)EIC, Address
Qualifier SS#
State # Municipal # Competency #
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION `r�? /Al LkTEe /Oe_... ` c44 1 F TR- 1�
Signature of owner and/or Condo President Date
Si
PiLt 14),M
Electrical
Phone
Square Ft. Estimated Cost (value) * / (D 0 0 i`el
r
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 ntractor to do the work stated.
� /tL
ature of o
actor or Owner - Builders Date
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner - Builder Date
My Commission Expires: My »eie�s�: `- --" -' °= -"''- 2. - 3- P2
f ..RY � .� • FICIAL f4CTAfiY S'� ',L
Q _ r `: SAM)RA Pi F3 TIEL
k c* COPAMISSICM 4J011WER
`• CC401:'1
• M r CO!''In'.s:,:•i EX P.
-1i "'f3
FEES: PERMIT 4 • RADON C.C.F. l o2 NOTARY S BOND
TOTAL DUE. 4fG• oI°
APPROVED:
Zoning
Mechanical Plumbing Engineering