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PAINTPERMIT '� APPLICATION FOR MIAMI SHORES VILLAGE Date 3. a6 • Or Job Address d `t4 , • / 97--- Tax Folio P /v r �� Historically Designated: Yes No / Tenant /toe 'E .i 4 Age Master Permit # Owner's Address dK /v` � f'itG1` 1 / f 5 / � E ��� 57-- Phone $ ( � t� 7 /0 Contracting Co. ►46owI1 ?I Address 6V g4 A C Qualifier 4(,0O/t( ss# hone ' ?S ( -7 Legal Description State # Architect/Engineer Bonding Company Mortgagor Address Permit Type (circle one) BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Exr* O a(Wr Square Ft. � Estimated Cost (value) 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 rk stated. Signa otary My Co FEES: PERMIT APPROVED: Zoning Mechanical e of owner and/or Condo President as •• : C agy , : ssion ExpirgUSAN REICH NOTARY PUBLIC STATE OF FLORIDA COMMISSION NO. CC797180 MY COMMISSION EXP. AN. 9,2003 RADON Municipal #1(- gc:2956 0 Competency # 9yB5 /1 Ins. C Address Address 3 /7/ o/ Date ,5 /7/O / Date 3 /d Building Electrical Plumbing Si otary as t s Contract My Conunission Expires: C.C.F. I fl NOTARY „(7 a Structural Engineer 3•_d/ x 3,,1144 P P U 6 OFFICIAL NOTARY SEAL l„ ANGELA M BECKER ■ ` OOYAGSSION NUMBER w ¢ CC786697 MY COMMISSION EXPIRES OF F\." NOV. 15,2002 BOND // p TOTAL DUE h b , Q DATE: 3 - 4 / OWNER'S NAME: /WI.' /U'�S Gl PHONE: /C9 7/0 ADDRESS: c2 `f. /✓• C• 0/ 5 ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: 3- V. 0 /0/ 5 r" CONTRACTOR & (if a licable) Q t3SC,©a / COMPANY NAME: V 1 S6ovn! - r IJi 44. PHONE: '17— r 7 /6 ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted. Walls t.A.4 q Z� Fascia Soffit of t.wre Roof of( Flower Bins b44-i-re" W 114 -1 131. �?7i Doors and door jams Shutters Awnings Chimney A,BQI,e (20A. 2V7/0/ Si ature of Owner Date APPROVED: Building • " icial MIAMI SHORES VILLAGE Paint Color Approval and Agreement 34)-k/ ate 1/A Garage Doors W 1i Railings vV -rr� Fences Metal /4014e . All brick (simulated or r 1n/l i1 tar Stucco Banding gent C Any other stucco features 1/076 . Accessory Buildings A/0 /X . Other Maur n%vtt- RaoF pRI P e4e 4- 6 7, !ntercoastal Green 672 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 c • ors will be s per • e attached sam es. a r 3, 06.0( Date Signature of Contractor 922 0 0 z cn r H z c to tzi *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION