PT-07-2052N C
eitSSetyld
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT, APPLICATION
FBC 2004
Permit No.
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'�IU"�2GTZ
Master Permit No.
Permit Type: PAINT PERMIT
Owner's Name (Fee Simple Titleholder) Jets 'r MIA it Mc6itir ieS.S Phone # (g-or) 754— N-1(2
Owner's Address 1ZS O lJ iC I Sa S-,
City M, t VtA,(t, x%,4-144 State F1.-
Tenant/Lessee Name
E -MAIL:
Zip 3.13t/
Phone #
Job Address (where the work is being done) S*H E'
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES
Contractor's Company Name N A
Contractor's Address
City
Qualifier Name
State Certificate or Registration No.
OWNER BUILDER:
Value of Work For this Permit $
Describe Work: pGu- Gf
NO
afair-
Phone #
> > State Zip
Phone #
Certificate of Competency No.
Type of Work: ❑ Addition / ❑ Alteration / [New / ❑ Repair /Replace
Pal/
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 permit
and that all work will he performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit roust 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 FO
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: . Ls a condition to the issuance ofa building permit with an estimated value exceeding $2500. the applicant roust promise in good faith that a cola 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 mist be posted at 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 be approved and a reinspeclion fee will be charged.
lCX fYJC'#' K**) C*#' Y. lt'********KK%%*'************ *FeeG,1�'X7ti5C]}** **:'K****** ** *ICYX'�C'X %'XX %'r.YY *YMXXXXK ***
J
Permit Fee $ �A/'l/L� CCF $ r �,1� Technology Fee: 1 •c)
Training /Education Fee $ 0- Z0 Notary $ `Jn ent $
Double Fee $ Zoning $
Total Fee Now Du
cc
MIAMI SHORES VILLAGE
See Reverse side —
PAINT COLOR APPROVAL AND AGREEMENT
All elements on the site must be listed and indicate the color to be painted
Directions: Please circle corresponding number to appropriate col
Walls:
Fascia:
Drip Cap /Drip Edg
Soffit:
Roof 1.
3
4
4
Flower Bins:
3
Shutters: 1.
Awnings: 1
Chimney: 1
Doors and Door .tai
Garage Doors: 1
Railings:
Fences:
2
3
s: I 2
2
2
3
3
3
4
4
4
4
4
4
4
4
3
All brick (simulate
Stucco Banding:
Any other Stucco '-
Accessory Buildin
OWNER'S AFF
compliance with al
Signature*"
The foredo
day of
or regular):. I 2
eatures:
s
3
Atta
c
LA
0
c
a
HC -120'
3
Other:
AVIT: I certify th
applicable laws re
me and
ng-inforniation is accurate and that all work will be done in
construction and zoning.
Own
instrument %
20(,.
who is personally known to
02(201W 61 As ail
NOTA
Sign:
Print:
My Commission Expires:
nature
r or Agent Contractor
• ack * wledged before me this �. The foregoing in ment was acknowledged before me this__
day of by
who is personally known to med-ot• who has produced
as identification hnd who did take an oath.
* * * *+Y** *ski* ********* * * ** *4 ** **,rare}Jr***** *,t** ti,tf*** *** *, tie********• k**a4*3Cak******xde**aY*4**x
c or who has piodu
ntification and why
* * * * * * * * * * * * * * * * * * **
APPLICATION APPROVE
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
BY:
iL/J f()
Plans Examiner
Preservation Board
Code Enforcement
(Revised 04/24/01