PT-10-7510
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SIrt to
Miami Shores Village
Building Department
1(4050 N.[2nd Avenue. Miami Shores, Horjda331 38
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2004
Permit No.
Master Permit No. \
0 7.r-T-0,1-7,777
7 !M f 0 3 2010
3Y : ..:.. -„
...........
Permit Tyre: PAINT PERMIT
Owner's Name (Fee Simple Titleholder) .5 uspAj R Z 6-o. Afe'
Owner's Address n /1. ) /J'a ,j-r-ppe.L
City /',!- '':`�,/ S/((7 /`'e State
Tenant /Lessee Name
E -MAIL:
Phone # —1 7
Zip 33/30
Phone #
Job Address (where the work is being done) S Se et
City Miami Shores Village County Miami -Dade Zip 33/50
FOLIO / PARCEL #
Is Building Historically Designated YES NO X •
Contractor's Company Name
Contractor's Address
Phone #
City
Qualifier Name
State Certificate or Registration No.
OWNER BUILDER:
State
C•'
rtificate of Competency No.
Value of Work For this Permit $ 5C0. CC) Type of Work: ❑ Addition / ❑ Alteration / [New / ❑ Repair /Replace
Describe Work: Pin% /) y of /✓liCk 1AC ,vie j iii '/D77./71
Application is hereby made to olxain a permit to do the \vork and installations as indicated. I certify 11181110 work or installation has commenced prior to the issuance of a permit
and that all work will he perlixnx.d to meet the standards (Wall laws regulatingconstmction in this jurisdiction. I understand that a separate permit must he secured lix
ELECTRICAL WORK. P1 1IMI3ING. 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 BEFOR[
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: .4s a condition 10 the issuance ofo building permit with an estimated value exceeding $2500. the applicant must promise in good faith that a copy of am.
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 al the job site for the first inspection which occurs seven (7) days after the building permit is issued. in the absence of such posted notice. the
inspection will not he approved and a reinspection.fee mill he charged.
:xr >:xx, x: **** ****** ** ** * ** **** ****** * **Fees> ********,**** * * **** ** * *********** ** * ** ******
Permit Fee $ CCF S Technology Fee:
Training /Education Fee $ • Notary $ Code Enforcement $
Double Fee S Zoning $ Total Fee Now Due $
See Reverse side —>
PAINT COLOR APPROVAL AND AGREEMENT
All elements on the site trust be listed and indicate the color to be painted
Directions: Please circle corresponding number to appropriate cc
Walls
Fasci<
Drip
Soffit
Roof:
Flows
Shutt
Awni
Chita
Door<
Gara!
Radii
Fens
All b
Stuc
Any other Stucco Features:
Accessory Buildings
t
SW 6352
Soft Apricot
51
SW 6350
rftricate Ivory
OWNER'S AFFIDAVIT: 1 certify that all the fe.•e g information is accurate and that all work will be done in
compliance with all applicable laws regulating c ' - 'ction and zoning.
Signature
•
Owner or Agent
The foretoing nstrume • nt vas l.owledged beforyme this
day of_ 2010. by`5"" rVl
tture
Contractor
The fore: • in instrument was acknowledged before me this
.20 .by
who is personally known to me or who has produced
who is p •i•sonally known to 1c or who has produced
10- ! .. � hTeltfla is ti d�iv
NOTAR
Sign:
Print:
My Commission 1•xpires:
on an
1
ho did take an oath.
as identification and who did take an oath.
C� ? }',> . NOTARY PUBLIC:
Sign:
Print:
V Qs
*Y.): T'XX X * * * * * * ** * * * * * * * * * * * * * * **
APPLICATION APPROVLiI) BY:
My Commission Expires:
Plans Examiner
Preservation Board
Code Enlorcement
(Revised 04/24/0;
At
1
2
3
3
4
t: 1 2
Thp/Drip Edge: 1
�
3
4
I 2
3
4
I
3
4
n- Bins: I 2
3
4
ors: I 2
3
4
ngs: I 2
3
4
ney: I 2
3
4
and Door Jams: 1 2
3
4
!e Doors: I 2
3
4
tgs: I 2
3
4
s: I 2
3
4
-id: (simulated or regular):
1
41"
3
4
n R�nriintr
7
A
_
Any other Stucco Features:
Accessory Buildings
t
SW 6352
Soft Apricot
51
SW 6350
rftricate Ivory
OWNER'S AFFIDAVIT: 1 certify that all the fe.•e g information is accurate and that all work will be done in
compliance with all applicable laws regulating c ' - 'ction and zoning.
Signature
•
Owner or Agent
The foretoing nstrume • nt vas l.owledged beforyme this
day of_ 2010. by`5"" rVl
tture
Contractor
The fore: • in instrument was acknowledged before me this
.20 .by
who is personally known to me or who has produced
who is p •i•sonally known to 1c or who has produced
10- ! .. � hTeltfla is ti d�iv
NOTAR
Sign:
Print:
My Commission 1•xpires:
on an
1
ho did take an oath.
as identification and who did take an oath.
C� ? }',> . NOTARY PUBLIC:
Sign:
Print:
V Qs
*Y.): T'XX X * * * * * * ** * * * * * * * * * * * * * * **
APPLICATION APPROVLiI) BY:
My Commission Expires:
Plans Examiner
Preservation Board
Code Enlorcement
(Revised 04/24/0;