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Miami Shores Village
Building D epartment
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit No.
Master Permit No.
BUILDING
$1SIIT APPLICATION
FBC 2004
Permit Type: PAINT PERMIT
Owner's Name (Fee Simple Titleholder)
Owner's Address Tv- 3/ %Us u% p , ' F A ye.
BY:
Phone # 3 05 _75 - 55 Ai
City J'Y» i Sh k es
Tenant/Lessee Name
E -MAIL:
State
FI-
AT/A
Zip 53 /6-0
Phone #
Job Address (where the work is being done) Q 2 3'
City Miami Shores Village County Miam% pacle 2 Zip 33 155
FOLIO / PARCEL # t F 3/ 0 L b 3 �; ��
Is Building Historically Designated YES `
Contractor's Company Name
Contractor's Address
ow, OWikvr
Phone #
City
Qualifier Name
State Certificate or Registration No.
State Zip
Phone #
Certificate of Competency No.
OWNER BUILDER: m /9-1:k-4/ENE ilmniatrks
Value of Work For this Permit ', ; ; ,�/ 'r' `. Type of Work: ❑ Addition / ❑ Alteration / [New / 0 Repair/Replace
Describe Work: �1^�Ssr� R C�P�tnJ �.S�il l�r� P CI4o1 1117194- t"tv'e- F° Ccc�
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 attaehntent 1sof a certified eopy'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 pertnht is lssuee In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. 4!
******** * * * * * * * * * * * * * * * * * * * * * * * * ** * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * ****
Permit Fee $�
Training/Education Fee $ Z®
Double Fee $ Zoning $
CCF
echnology Fee "'' / °r
�, a Enforcement $ `
Tgtal ee' Now Due $ 2 e 3
cc�
r
`,
MIA o
ORES 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 color sample.
Walls:
Fascia:
2
3 4
1 2 dgb
Drip Cap/Drip Edge:
Soffit: 1
Roof: 1
4
4
4'
3
4
Flower Bins:
Shutters:
3
4
2
4
Awnings:
Chimney:
Doors and Door J
Garage Doors: 1
Railings:
Fences:
2
4
2
1
All brick (simulated or regular):
2 3
2 3
2
3
4
4
4
2
Stucco Banding: 1
Any other Stucco Fer.
Accessory Buildings
OWNER'S AFFID
compliance with all
Signature
tures: 1 2 3 4�
Qtthr:
A
and
1.0 dr IS
.,ESN
\Pr
VIT: I certify that all the foregoing information is accurate and that all wor C will be done in
plicable laws regulating construction and zoning.
Owner o Agent
The foregoing instrument was a knowledged before me this 1
day of OCJD btr ,2001,by M (bleb ene NAddo
rr
who is personally known to me r who has produced r L .1) t_
Ix--
NOTARY PUBLIC:
As ident cation and who did take an oath.
NOT Uta
Sign: '! ,I
Print: i1u �ZL
My coumiiisiw
4
4340 11)
SHUMINTRi1 A D1 UZZANEIL
' �� rely Commission moires Apr 28, 2010
f>, �fi � �s, # DD 529448
APPAL. OWIW ., ._ . ■11/ -"NV'
Notsty Assn.
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of ,20_,by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Plans Examiner
Preservation Board
Code Enforcement
(Revised 04/24/07)