PT-07-1157ocol Miami Shores Village 081c Aah-L°
V} Building Department lua"
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING - , , Permit No. 9101 -- 11s--
PERMIT APPLICATIO
9 Master Permit No.
FBC 2004
Permit Type: PAINT PERMIT BY: ------ ----- - - - °-
Owner's Name (Fee Simple Titleholder) k (-4,4l E . ,r)rj1e Phone # � J�J. ®aCQ
Owner's Address
City (\ State L Zip
Tenant/Lessee Name Phone #
E -MAIL: 34\ c`{1 kArn > h• h- L jam✓
Job Address (where the work is being done) C_
City Miami Shores Village County Miami -Dade Zip 3B\ '�
FOLIO / PARCEL #
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's Address
City
Qualifier Name
State Certificate or Registration No.
OWNER BUILDER:
Phone #
Zip
Phone #
Certificate o - . _ . etency No.
Value of Work For this Permit $ C Type of Work: ❑ Addition / ❑ Alteration / ONew / ❑ Repair/Replace
Describe Work: ep.tt\-k ar-seLgyNe_. �: \ Zc r\
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 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 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 reinspection fee will be charged.
* * * * * * * * * *, * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * ** ****** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Permit Fee $ 60 CCF $ lJ -IC J Technology Fee: 1' 00
Training /Education Fee $ ac9-0 Notary $ 5. CO Code Enforcement $
Double Fee $ Zoning $ Total Fee Now Due $ G
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 color sample.
Walls: %./
2
3 4
Fascia: 12.) 3 4 number.
Drip Cap/Drip Edge: 1 v"--( 3 4
Soffit: 1 2 v°"-- CSI:) 4
Attach color samples with name and
Roof: 1
Flower Bins: 1
2 3 4
Shutters: 1
2 3 4 2B
stone house
2 3 4
Awnings: 1 2 3 4
Chimney: 1 2 3 4
Doors and Door Jams 1 2 3 CV5
Garage Doors: 1 2 3 4
Railings:
Fences: 1 2 3
2 3 4
All brick (simulated or regular): 1 2
Stucco Banding:
Any other Stucco Fea
Accessory Buildings
1 2 3
/lj_2 3 4
`t; "A„} _ , Other:
1039
SW 611
Smoke Topa,
SW 6113
Interactive Cream
OWNER'S AFFIDAVIT: I certify that all the foregdirig i-f formation is accurate and that all work will be done in
compliance with all applicable laws regulating construction and zoning.
Signature
weer oi Agent Contractor
The foregoing instrument was adlcnowledged before me this The foregoing instrument was acknowledged before me this
day of ne, 20 Cit7by alLa ilailatiter , day of , 20 , by
who is personally known to me r who has produced : J who is personally known to me or who has produced
01 i b As identification and who did >�`�t�io,5 as identification and who did take an oath.
NOTARY P C: /r"'^ , �/ `; 0� 0 C9 `®
' /war r �\9 0' ®�"®
0# 00"
Sign:
Print:
My My Commission Expires:
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * * **
**
APPLICATION APPROVED BY:
Plans Examiner
Preservation Board
Code Enforcement
(Revised 04/24/07)