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EXPIREDPERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) Date !� \ \' 1 Job Address Legal Description /‘ Y 4ii 1 I z , ,// j/ ,faster Permit # Owner / Lessee / Tenant e ? 4-8 i 6 - d Owner' Address al9 A./15 ?? Contracting Co. \ \ \- T..,,, t_ -k , , ` , ,, _"\ k,- L, _ Address Qualifier \L .30 State D Competency D JF7 c 14% Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN WORK DESCRIPTION Square Ft. Estimated Cost l ;? ,, 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 ZECORDING YOUR NOTICE OF COMMENCEMENT). 1 •.pplication is hereby made to obtain a permit to do work and installation as indicated above, and In 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 Jermits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING, and MECHANICAL work. WNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work Ill be done in compliance with all applicable laws regulating construction and zoning. 'urthermore, I authorize the above -named contractor to do the work stated. ignattir; of Owner and /or Condo President MOTARY PUBLIC, STATE br' i y--r' MY COPr(MIs - 13oND ate: IJ �w ?iiic�l: NOV. 29, 1991'4 NOTARY PUBLIC UNDERWRITER£] to . as to Owner and /or I o o President y /.mmission Expires: . * . * 3RMIT FEE: APPROVED: THR * L\ fir r.. Zoning Building SS# ?, , �� - - r. Signatur Date: Ins. Co. Nota s to Contractor My Commission Expires: * * * * * * Fire Tax Folio // 14,6, J54W ` X1' ` 1�9 n C' 10 \ D •■ t ractor or Owner- Builder I TAR" .,, 'U9LiC, C i'" 13 1;LORICI. .�` 1. / •�.c:C:� 21, orJ IJ:. J(3,L,C IJNDERWRrTCRS'. f - ? j q L � Ow r r- Bualder Other Phone7 7 Phone 7,, . s: Electrical * * * Mechanical Plumbing Engineering Date Type Insp' Permit No. Name MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Address Company A J-^ + // ,,,, ]f� Phone # V • 15? 6 - co b° For Inspect n Name & to Approvedl : Correction ❑ Re- Insp'n Fee ❑ Ti.se X758 62 7 Cv MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 11 Time Type Insp'n Permit No. Name Address Company J Phone # _3 O S- ? O c . 0 IG� , 0 For Inspector: ) Name & Date Approved Correction Re- Insp'n Fee t Tenant/Lessee Name BUILDING PERMIT APPLICATION FBC 2001 Permit Type (c' e : Building E ectrical Plumbing Mechanical Rgofing J 7 99,s- _ 7/L3 Owner's Name (Fee Sump e i es o i er) p +� i+n 14..s7/ 7 9 P Phone # L�' o r) ‘Z - S 9C1' Owner's Address 0.99 /.ti 9c? City rby -1 State Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Is Building Historically Designated YES NO Contractor's Company Name /04 /74 ` v Phone Contractor's Address /Y76 /t- /3o J/ State 33/6 City I1, 141 ( Pr Qualifier $ Value of Work For this Permit ,-, / County Escrow Fee $ / y D Education/Training Fee $ Miami Shores Village Building Department Zy9 AO 9,f s74-. Tech $ 6S a Permit No. PO `1 ` b `'j Master Permit No. Zip Say Phone # Zip Phone # ea (4 1)PQ 17t/e1e WO A 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 30 00 -b Zip Architect/Engineer's Name (if applicable) Architect/Engineer's Address City ''` State Zip Square Footage Of Work: Number of: Bays Stories Families Bedrooms Baths Type of Work: ❑Addition DAlteration :New ❑ Repair/Replace ❑ Demolition Describe Work: * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** �t / , Permit Fee Sj v Notary $Si 0 c) Scanning $ Radon $ Code Enforcement $ Bond $ Struct $ 'Minus Plans Check Fee $S . D d Total Fee Now Due $ f 3 �q u (Continued on opposite side) 40 �� Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) / 1 Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Signature NOTARY PUBLI Sign: Print: My Commission Expires: APPLICATION APPROVED BY: chc7/7 /03 / Owner or Agent Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. The foregoing instrument was acknowledged before me this / day ° 20 . by �t7 RPiV »9 l.(e , who is person known to me or who has p roduce ��) Q hgy� o 1yd did take an oath. r. , � �l4pY P KL'Y1 P� __Commission # DD096211 • Fjp ires ill Appr110, 2006 lant1 e BnnM ,, g , Signature '`-;( Contractor The ':going instrument was acknowledge day of d who i 'ersonally known to me or who has produced as identification and who did take an oath. (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. W e? \ e*ePlans Examiner Engineer Ci /U Zoning r , • MIA1bII SHORES VILLAGE Paint Color Approval and Agreement DATE: .Je? u w^1 �.3 ZOU !� OWNER'S NAME. > e i/E57,0 - / PHONE: ADDRESS: 2-ii?" yr *********************************** * * * * * * * * * * * * * * * * * * * * *. * * * * * * * ** ADDRESS OF SITE: 4 f 9 /140 9cf CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted. Walls He— /1/ Fascia /7 -Z? Drip Cap/Drip Edge 8iV D ve Soffit n -Z 7 Roof w/ At Flower Bins A / Shutters $ Awnings •/4 Chimney AV& Doors and door jams /iG - fiat, Garage Doors ,jam— // Railings A b Fences /% Decorative Metal v / All brick (simulated or regular) /Ir ,"41 Stucco Banding p► / if Any other stucco features `I Accessory Buildings AV& 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. Fu ermore , the paint colors will be as per the attached s• ple Signature of Owner Date Signature of Contrac or Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED: WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION Building Official Date /J 4/23/01 140 — /V/ /q c e t4' t/c // - 2-7 - °1/2F- • Paint Color Approval and Agreement ,Date Owner's Name Owner's Address City Job Address (where the work is being done) City Miami Shores Village Is Building Historically Designated YES Contractor's Company Name (if applicable) **************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** • _ Walls. i- ` S c) Cf Fascia HC, DD � r i Drip Cap /drip Edge 6)'1/N Soffit G Roof Flower bins Shutters Awnings Chimney Doors and door jams All elements on the site must be Garage doors ` I3C - 1 l Railings Fences State Zip 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. Signature APPLICATION APPROVED BY: • Miami Shores Village Owner or Agent ✓ ) r! P& Z Officigl —` "� Phone # A\19 r)vcc'. 96 ifiN County Miami-Dade NO listed and indicaf 2B 1509 spanish olive - ..TTY *. * * * * * * * * * * * * * * * * * * ** BENJAMIN MOORED COLORPREVIEW HC Date Date a) _c • cv a) 0 F , ers HC -27 amples MIAMI SHOREFVILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date Type Insp'n r r lnal Permit No.bc Da/ Name C'u'e S4 nc_)rp Address NIL crs1_ Company ACTINIC '- Phone # Inspection Date Approved Correction Re- Insp'n Fee Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 1 /22/2004 Applicant: BRENDA Owner: WESTHORP JOB ADDRESS: 249 NE 98 Contractor COMPLETE HOME PAINTING Local Phone: 305 - 895 -1368 Parcel # 1132060134400 Signed: (INSPECTOR) Signed: (Contractor or Builder) Building Permit Permit Number: BP2004 -64 WESTHORP BRENDA ST Contractor's Address: 1476 NE 130 STREET Permit Status: APPROVED Permit Expiration: 7/18/2004 Construction Value: $2,100.00 Work: EXTERIOR PAINTING BY: Page 1 of 1 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 16 & W1/2 LOT 17 BLK 32 LOT SIZE Fees: FEE2004 -673 FEE2004 -674 FEE2004 -675 FEE2004 -676 FEE2004 -677 Description Building Painting Fee Notary Fee CCF Training and Education Fee Technology Fee Total Fees: Amount $60.00 $5.00 $1.80 $0.60 $1.50 $68.90 Total Fees: Lt Total Receipts: $5.00 a D u In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself, my agent, servants or employes. o�1 PROPERTY OWNER New Construction Name I, � L. r� Address 97/2 'W D 4JEs Home Telephone ?oic Repair Business Telephone 381 71-57 ( Fax r ±x \ �r, (1 �'D x- TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'! Attachment Other Add'l Detachment Other INSTRUCTIONS - The following steps must he taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the property owner 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. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION 1k Job Address: 4- 9 A/e q 7 S7: Address Apt. City �n Description of Work N4 N 7 (= 'C Folio Number Lot Block Subdivision Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PB PG PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. Z7' e70" ' c l D ('-II 4 + I s44& -e-+ State PERMIT APPLICATION Zip Zoning Linear Feet Square Feet Units Floors Value of Work 400 Bldg Value / 7 ®p CX)cp. Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name Page 2 IMPORTANT NOTICES 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. 1. AFFI - 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 to 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, 1" 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. STATE FLORIDA, COUNTY OF Owner STATE OF FLORIDA, COUNTY OF MIAMI-DADE o f Signatur weer p rio_a_vs of Contractor / Qualifier PERMIT APPLICATION O Print Name / 7 Print Name orn to and subscribed before me this (n day .f L� Sworn to and subscribed before me this day of � , .t -,f Florida __ Signature of Notary Public - State of Florida PRY Pc, Ih�A� I H ... .. �. SEAL: 2 fir ,. 'C CL B Via,. .;, a ar' ); �car.:sMow rJUe.� ". � `a CC786697 . " OF F4O . 5,`'. . Personally known OR, Produced Iden Personally known OR, Produced Identification SEAL: Type of Identification Produced: Type of Identification Produced: ELECTRICAL TYPE Minimum Fee QTY. TYPE, Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Fire Pump Outlet, Switch Signs A/C Central 8 -15 Ton Fixture - fluorescent Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New NIECHANICAL TYPE; Minimum Fee Q. FY. TYPE Condensate Drain QTY. . Generator Q . I • Y . ' Refrigeration, Tons QTY A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C WaWWin. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUMBING TYPE A/C Condensate Q TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture Q TYPE Soakage Pit QT1 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- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater 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 and quantity(ies) in the space provided below. • RECEIVED AND REVIEWED BY: DATE: Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ 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 ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ ‘o v)t $ (sq.ft. = x/1000 x ¢.60) (¢.005 /sq.ft.) (¢.0l /sq.ft.) REVIEWED AND PREPARED BY: SECTION 57h7 Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official DATE PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES TOTAL $ C� ISSUING OFFICIAL DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com Miami Shores Village 10050 NE 2nd Avenue Building Permit Phone: 305 - 795 -2204 0 : Permit Number: BP2002 -909 Printed: 5/10/2002 • Page 1 of 1 Applicant: PATRICK DUFFY Owner: WILSON CHARLES JOB ADDRESS: 249 NE 9 `V ) Contractor Contractor's Address: • Local Phone: Parcel # 1132060134400 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 - 70 LOT 16 & W1/2 LOT 17 BLK 32 LOT SIZE S' Fees: Description Amount FEE2002 -2684 Building Permit Application Fee $60.00 Total Fees: $66.20 FEE2002 -2685 Notary Fee $5.00 FEE2002 -2686 CCF $1.20 Total Receipts: $0.00 1 Total Fees: $66.20 9 Permit Status: Approved Permit Expiration: 11/6/2002 Construction Value: $1,200.00 P " Work: EXTERIOR PAINTING AS PER AGREEMENT j If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection 2 fee is $50.00, which must be paid in advance before calling for another inspection. This Permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed: (INSPECTOR) BY: b�'l Ob r Sc79 8 N In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself, my agent, servants or employes. Signed: - (Contractor or Builder) BY: 66.20 MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: SQd /� OWNER'S NAME: PPr qc,/4- �• ADDRESS: g '2, 8 ni G z of ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: cP-'- i NE 9 $ CONTRACTOR & LICENSE (if applicable) ®wN_ COMPANY NAME: PHONE: ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted. Walls Fascia Drip Cap/Drip Edge Soffit Wil --re Pl , ; Roof t f i {\iee s e 6k A v Flower Bins Le Shutters rJ/ A Awnings 0 0111 Chimney Doors and door jams (u ( e� L� IcV Garage Doors to f{ f- Railings (Air-Fr Fences Decorative Metal All brick (simulated or regular) Stucco Banding Any other stucco features ( u , Accessory Buildings Other OWNER'S AFFIDAVIT: I certify that all the forego and that all work will be done in compliance with all construction and zoning. I authorize the above -names do the work stated. Furthermore , the paint colors will be as per the attached sample V02_ Signature of Owner '1' Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED: Building Offic AVA 3 /1/0:1 Date PHONE: (cr) ��P -5tt WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Addresse2 Ale f 0 G 6 V Tax Folio I- 3 a d (o -013 - 4 4 0 0 Legal Descnption.$ ( 1h I M D r-� b 10-'2,0 i6 W /�Iistorically Designated: Yes No !/ Owner/Lessee / Tenant J( fl\ , Q / Z A. C . A 13 n (T T Owner's Address //J 0 g 3 �A ht rfl o 6041 C©0f 2 C i 1 a Phone $D — Contracting Co. Qualifier SS# Phone State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Mortgagor Alo Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAV,rG FENCE SIGN WORK DESCRIPTION A i .4J J S / d 2 �-' Square Ft. Estimated Cost (value) '8 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. e £8 I -30 - P ignature of own an or Cent resident Date Signature of Contractor or Owner- Builder Date Notary 2s t o Owner and/or Co nd P sid ent Date My Commission Expires: FEES: PERMIT Address Address d dress (}� IAL NOTAIY SnAI ELLEN I- IAYWOOD NCTA Y PUBLIC Si,".,:;% Or LORIDA COMMISSION NO CC20.r07 cOA;M fSSICN' RADON C.C.F. ► NOTARY Master Permit # Notary as to Contractor or Owner- Builder Date My Commission Expires: TOTAL DUE tit' APPROVED: Zoning Building ) 4 "k Electrical Mechanical Plumbing Engineering