PT-07-2193Miami Shores Village imemEwM1
Buildin g Department
artment Fx� 10050 N.E 2nd Avenue, Miami Shores, Florida 33138 BY: w"--
Tel: (305) 795.2204 Fax: (305) 756.8972 )(�''�j
Permit No. 0 211 b v
BUILDING
PERMIT,APPLICATION
FBC 2004
Permit Type: PAINT PERMIT
Owner's Name (Fee Simpl Titleholder cse
Owner's Address C' ij) j 0 1
City ) )/i1,fLe Lak. Lto)°d State '!"27/
!
Tenant/Lessee Name
E -MAIL:
Master Permit No.
1) ff '�r7 Phone #
Zip _ ? /4. 1
Phone # (') ,3 fly
Job Address (where the work is being done) ( D N / /c .5
City Miami Shores Village (! County Miami-Dade. Zip
—
FOLIO / PARCEL # 1/ f 36 3 oc Xt,x;L,
Is Building Historically Designated YES 1 . i 'N
Contractor's Company Name tt tire
Contractor's Address
City State
Qualifier Name
State Certificate or Registration No. Certificate of Competency No.
3/
Phone # J3e--)) 33ct-1 S- y
Zip
Phone #
OWNER BUILDER:
Value of Work For this Permit $ Type of Work: O Addition / 0 Alteration / ONew / O Repair /Replace
Describe Work: / t3JJ 6
Application is hereby made to ottain 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. 1 understand that a separate permit must he secured for
ELECTRICAL. WORK. PLUMBING, SIGNS, WELLS. POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
"WARNING 1'O 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: As a condition to the issuance of a building permit with an estimated value exceeding $ 2500. the applicant must promise /11 good faith that a co1y oldie
notice of commencement and construction lien law brochure will be delivered to the person whose properly is subject to attachment. Also. a certified copy ofthe 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.
*************x xxx x***** x*** x********** F. `ees** *x * **x * * * * * * * *www*xxxxx #a **wwd:xaY9:xxxxxx ***
Permit Fee $ 6040 CCF $ • Techn
Training /Education Fee $ • 2.0 Notary $ 5.00 Code E cement $
'7. 3 '
Double Fee $ Zoning $ Total Fee Now ► $ '� ' x
See Reverse side -
MIAMI SHORES VILLAGE
Directions: Pleas
Walls:
Fascia: I
Drip Cap /Drip Edge:
Soffit:
PAINT COLOR APPROVAL AND AGREEMENT
All elements on the site must be listed and indicate the color to be painted
circle corresponding number to appropriate color sample.
Roof
Flower Bins:
Shutters:
Attach color samples with name and
number.
Awnings:
Chimney:
Doors and Door Jai is:
Garage Doors: I
Railings:
Fences: •
All brick (simulate
Stucco Banding:
or regular):
l2
Any other Stucco Features:
Accessory Buildings
12 Trim: Icy Tundra ECC -38 -2u
3 Accent: Sea Fern ECC -38 -3°
OWNER'S AFFI iAVIT: I certify that all the foregoing information is accurate and that all work will be done in
compliance with all applicable laws regulating construction and zoning.
Signature it
Owner or Agent
The foreaoi g�insttrrument wah ackn )wledged bet re me his The foregoing instrument was acknowledged before me this
day of 1't�!sz J 207. by �L i f'�_:' y , day of . 20 _. by
who i; personally known to rpe or vho has produced , �;� �tr,� . who is personally known to me or who has produced
Signature
Contractor
O.I1. As identification and whc 4A4i(' '•
.b•
NOTARY 1 ! I ��G � co o f'
Sign:
441( s'ele
Print: ,� ri'�
My Commission Expires:
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
********** xxxxx****** xxxxxx** * ** * * * * * * * * * * * * * * * * * * * * * * * ** ***
APPLICATION APPROVE) BY:
VI?
Plans Examiner
Preservation Board
Code Enli rcement
(Revised 04/24/Oi