PT-07-2122RECEIVED
OCT ef. 7 200
BY:
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. r 1 2-"
Master Permit No.
Permit Type: PAINT PERMIT =
Owner's Name (Fee Simple Titleholder) Elsie_ iT E// f J
Owner's Address 73 3 7 N. W. �'`� e�,
City O`/ gm I State
Zip
Phone # 75-4
6' 2 7 If 6
33/x"0
55'2 7e) 7j-
3 1 5 78 86
Tenant/Lessee Name L ?51-- r' 6
E-MAIL: e-k5fee_f QJ��c��aAvAiir e a
Job Address (where the work is being done)
Phone # 5,05z /7.6-
City , _Miami Shores Village ;C Countyrf Miami -Dade
FOLIO / PARCEL #
Is Building Historically Designated �E� :i \,
zip 3 3/ S
Contractor's Company Name atJvj or Phone #
Contractor's Address
City State Zip
Qualifier Name Phone #
State Certificate or Registration No.
OWNER BUILDER:
Certificate of Competency No.
Le
Value of Work For this Permit $ /. 2 0 0 Type of Work: O Addition / D Alteration / ONew / O Repair /Replace
Describe Work: Pg / %' / ��7c J�-i` o�-
�
Application is hereby made to Main 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 regulatingeonstruction 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 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 WITI-I YOUR LENDER OR AN ATTORNEY BEFOR
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: .4s a condition to the issuance of a building permit with an estimated value exceeding $ 2500. the applicant must promise in good Pith that a col) of the
notice of commencement and construction lien law brochure m4'1 /! 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 he approved and a reinspection fee will be charged.
de****xxxxzxxxxxxx*********aY ***********Fees*********** *** Yat*****4cd:************xxxxrxx**
Permit Fee $ 60.0° CCF $ 1 =2.0 Technology Fee: 1.50
Training /Education Fee $ 0 40 Notary $ 54 Code Enforcement $
Double Fee $ Zoning $ Total Fee Now Due $ 6 W, 10
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:
Drip Cap /Drip EEdgC:
Soffit:
Roof: I
Flower Bins: 1
Shutters:
4
4
4
[ 2 3 4
Awnings: 1 2 3 4
Chimney:
Doors and Door Jay is:
Garage Doors: _I
Railings:
Fences:
I 2 3
All brick (simulated or regular): Pk-!P/
Stucco Banding:
[
Any other Stucco Features: I
4
Accessory Buildings
with ngme and
OWNER'S AFFIQAVIT: t certify that all the foregoing information is accurate and that all work will be done in
compliance with al applicable laws regulating construction and zoning.
Signature
Owner or gent
The foregoing instrument was acknowledged before me this
day of OW . 206\ . )y E144, Y I t \tit'
= as who is personally known to me or who has produced
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of . 20 . by
who is personally known to
NOTARY PUB
Sign:
Print:
My Commission Expires:
lc or who I
As idi tit•ication
ias poduced
a.nd who did ta
**** ****** *****hex***
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
** *** ******** * ** ***** ******* ** ***u******** **** &***r* *********************
APPLICATION APPROVE) BY:
by ,
. 444,1
Plans Examiner
Preservation Board
Code Enforcement
(Revised (14/24/01