836 NE 100 St (6)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date/2 mss/ irt G(Job Address / 310 u LF / CO S / Re& / Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant ,/Clu 1J Ele L c/ZE'j 4 s sie` . Master Permit # 4/ q 9 3
Owner's Address 8 s b k/ o d t P t o 144. L [ (.B? ct R Phonyk Se S 158 /57/ (�
Contracting Coy J f / 'f Address 30c 7 7 6 s ���sitie
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one). WILDING LECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTIO s� g B L-= L'
ZrwrnsW —
Square Ft. Estimated Cost (value)k '4194 0 0.0 0
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO S ULT 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.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date Notary
My Commission Expires:
FEES: PERMIT
RADON
APPROVED:
Zoning IiLY de/e/ Building
My
a
gnature
ontractor o
Owner- :. der
1/ am0 z J Zs /7
LL ADYS J VILLAR
to ontra or or • e'r= Btiilde�p } i
mmission Ex
MARY LIC STATE OF FLORID
COMMISSION NO
C.C.F. ' tP o NOTARY ,)
Electrical
- 60
BOND
TOTAL DUE
Mechanical Plumbing Structural Engineer
DATE," 44-‘ku-c
OWNER'S NAME •
ADDRESS 3 lo E )00
* * * * * * **
ADDRESS OF SITE:
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
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
sarxtplgs.
W-7 20 260
Signature of Owner D'te Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Drip Cap/Drip Edge CocaMw� `-ci ✓g
Soffit Cmeet.2 , 40 ✓b
Roof N A
Flower Bins Lto ht`f e
Shutters 1.) A
Awnings pV
Chimney pc/ A
Doors and door jams W h e
Garage Doors .v h,` e
Railings y,! A
Fences J A
Decorative Metal A
All brick (simulated or regular) J A
Stucco Banding p A
Any other stucco features A
Accessory Buildings tLJ 4
Other f�
All Elements on the site must be listed and indicate the color to be painted.
Walls .Cm caa S lttlI
Fascia C c� ► ayy - Gr RA V 9' 321
APPROVED:
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
2P
Building Offficial
za, zoo I
Iterd cc F
• Mit4 em l pe t d,
************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
s%).)1,,
Date
PHONF4<lo5
Coconut Grove SW 2428
Cocoa Shell SW 2432
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01