PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date s7- Z-" 1 Address .Y//75 k1 /0 54 Tax Folio
Architect/Engineer
Address
Bonding Company O x) Address
WORK DESCRIPTION (.L.eRtc. 0R _ PA -iJ e
Square Ft. "Z.-GYjh
/t'a
Estimated Cost (value)
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant) AAJQtiC - 2. • v,(_- /I a rt-- 975 Master Permit #
Owner's Address / /71 (c '2__ Phone 2( ,3:1 /— '3 O 1
Contracting Co �::- " ;a �.:. �:��. a , . i/ d` �" dress C J' Q \ V1
Q - �
Phone L4 9,— 'JLO p `
1 4-
State # Municipal # Competency # Ins. Co.
Mortgagor NAO k Address
Permit Type (circle one): ILDING LECTRICAL PLUMBING MECIIANICAL ROOFING PAVING FENCE SIGN
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
constructs
Commission Expir
APPROVED:
Zoning
Mechanical
as to Owner an
FEES: PERMIT �D RADON
I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
Furthermore, I authorize the above -named contractor to do the w. stated.
e of owner and/or Condo President
•
•
•
•
•
JANE C. CARTER
COMMISSION # CC842965
EXPIRES JUL 2S.2003
BONDED THROUGH
VANTAGE N •TARY
NOTARY
PUBLIC
STATE OF
FLORIDA
7
1rri';•
•
1
Buildin POS
Plumbing
9-Zo -o0
Date
9 -24 -ob
C.C.F. NOTARY J BOND
Electrical
TOTAL DUE
Date
5
Date
Structural Engineer
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE: ' Z — �C7
OWNER'S NAME: /q /)Q ft_ /1 f v - it) mot_
ADDRESS: / I - 7) ((DA-
TELEPHONE: 3'& 7 — 0 3 0 S
********************************** * * * * * * ** * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE:
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: LJS'rar1 � A Sfi JJc f ft,) 'au
COMPANY TELEPHONE: q5 e 3 c/
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls !/ 54/L 4_1,5
Fascia '
Soffit
Roof
Flower Bms
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 m 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
samples.
Signature of Owner Date
Signature of Contractor
(if applicable)
MIAMI SHORES VILLAGE, FLA.
JOB
ADDRESS
N_ 106
INSPECTION /L 7, 14-ae.--J
TIME READY 4 - r7/- -7C.
REMARKS.
INSPECTOR DATE