PT-10-1092tbA
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BUILDING
PERMIT APPLICATION
I9%A 1 otAiNcretlAiD � -
Miami Shores Village
SIVIgn
JUN 1 5 2010 gg
l..
Building Department BY: .. ....................
>0050 N.E.2nd Avenue, Miami Shores, Florida 33138
(305) 795.2204 foe: (305) 756297.2
P-10
—A ^^
Permit No. }�
Master Permit No.
FBC 2004
Permit Type: PAINT PERMIT
Owner's Name (Fee Simple TitleholderCh_ {C /I Le # E.5142 52-1- OC A am
Owner's Address E) I1 �) Vj • * °T
City 1 0 1 State Zip 33I
Tenant/Lessee LName Phone #
E -MAIL: CI 1 � ) r $(.i,0011 V-(rocrn > C 1
Job Address (where the work is being done) CroaD l e • % i fa
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL # wwF
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's Address
City State
Qualifier Name
Zip
Phone #
State Certificate or Registration No y' Certificate of Competency No.
OWNER BUILDER:
Value of Work For filtis Permit $
Describe Work:
Type of Work: 0 Addition / 0 Alteration /New / 0 Repair/Replace
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 pemmit
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.....
"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."
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 fist inspection which occurs seven (7) days Ater the building permit Ls issued In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged
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Permit Fee $ CCF $ Technology Fee:
Training/Education Fee $ Notary $ Code Enforcement $
Double Fee $ Zoning $ Total Fee Now Due $
See Reverse side —>
PAINT COLOR APPROVAL AND AGREEMENT
All elements on the site must be listed and indicate the color to be 'minted
Directions: Please circle corresponding number to appropriate color sample.
Walls:
2
3 4
Fascia: 1
Drip Cap/Drip Edge:
Soffit: 1 2 3 4
Roof: 3 4
Flower Bins: 1 _3 4
Shutters: 1 A2 3 4
Awnings: 1 N.VA2 3 4
Chimney: 1 k-V A 3 4
Doors and Door Jams: 1 �2)�Y 4
Garage Doors: 1 3 4
Railings: 1 1\1 j 3 4
Fences: 1 Z''' 3 4
3 4
3 4
All brick (simulated or regular): > 1�1ZA
Stucco Banding: 1 fN 3
Any other Stucco Features:
Accessory Buildings Other:
OWNER'S Ty that all
compliance ' t all a ' licable 1 ws regulating
Attach color samples with name and
number. ,
oing information is accurate and that all work will be done in
on and zoning.
Owner or : l"5 y i Contractor
The foregoing _
g mg instrument was ; � . � � awledged � : � re me this The foregoingu�strument was acknowledged before me this
day of 2i , 20/0', by `- i,� ►,- �,J �i Lda Ji day of , 20 , by
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOT `` PUBLI NOTARY PUBLIC:
Sign: /At._ .1.0... Sign:
Print: 1p" �.���� Print:
My Commission Expirdrwi ;agAs irEN a
� ; My Commission Expires:
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APPLICATION APPROVED BY:
Plans Examiner
Preservation Board
Code Enforcement
(Revised 04 /24/07)