1240 NE 100 St (13)•
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date ' C.(0 t Job Address 1 1 4 0 E- \ 60 5 \ Tax Folio
Legal Description Historically Designated: Yes /i No
Owner/Lessee / Tetuan* G L \ G E \ eN (9^ ri.e e Master Permit # �8 � r
Owners Address 1 E1 a ,1 C < 6-0 �J� Phone 3 O0
Contracting Co J tel/IMPO Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company
Mortgagor Address
Permit Type (circle o BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
My Commission Expires:
Address
Square Ft. Estimated Cost (value) '/ 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.
I Signature of owner and/or Condo President Date 81gr►ature of �gntractor or Own r- Builde zyi r '
$ D �l 443
Notary as to Owner and/or Condo President Date Notary alto Contractor or er- Builder Date
My Commission Expires:
C.C.F. 1 4 NOTARY S BOND
3 of
FEES: PERMIT RADON
tee r 9 vf'[e sci,�l a buwtMx)
APPROVED: ouSt° � TOTAL DUE
3/ 411°
Zoning �� Building _ Electrical
S ze. Ov v-tcer
Mechanical Plumbing Structural Engineer
MIAMI SHORES VILLAGE
DATE: 3 S ® c
OWNER'S NAME: C.. a. 1 E e 1 key PHONE: 3c5 Z ~ytAu.U(.0
ADDRESS I '1 �o C \ c3'z) s
* * * * * * * * ** ************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: \ )- 1 a � <
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
***** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls
Fascia
Soffit
Roof
Flower Bins
Shutters
Awnings
Chimney
Doors and door jams
Garage Doors
Railings
Fences
Decorative Metal
All brick (simulated or reg ► ar
Stucco Banding
Any other stucco features
Accessory Buildings
Other
Paint Color Approval and Agreement
i\;9- L1/4
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
same - s.
Signature of Owner Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED: /ow _qe rCf
�i��e
& 374 o/
Building 0 cial ate
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
Golden Glow
lA10 -4