PT-07-2219to.sikve
Miami Shores Village
Building Department
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1iG
10050 N.E.2nd Avenue. Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972 yy
Permit No. 1 Za.
Master Permit No.
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: PAINT PERMIT
RECEIVED
Owner's Name (Fee Simple Titleholder) t _.) / /4 0Y v-e5
Owner's Address /a /719 /v l U % 7W y-,^G? f qo
City% /)emi/ ,j®/ !' State
Tenant/Lessee Name
E -MAIL:
Zip
Phone# .30,5 — `75, -- b2'6,7
Phone #
Job Address (where the work is being done) /C2 9 , , - C f/ / Z'" tP"'c c
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL #
r"
Is Building Historically Designated YES NO ��� i c 1 ;`
Contractor's Company Name
Contractor's Address
Phone #
City_ State
Qualifier Name
State Certificate or Registration No.
OWNER BUILDER: 3esr3
Zip
Phone #
Certificate of Competency No.
Value of Work For this Permitt $ 6eZ5,° 47 Type of Work: ❑ Addition / ❑ Alteration / ['New / ❑ Repair /Replace
Describe Work: y/ % C/ ' e /c,Yl o
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 ofall laws regulating construction in this jurisdiction. I 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 FOE
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTENT) TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORI
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance ofa building permit with an estimated value exceeding $2500. they applicant must promise in good faith that a copy of the
notice of commencement and construction lien law brochure will be delivered lathe person whose properly is subject to attachment. Also. a certified copy of the recorded notice
of commencement must he 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 reinspectian fee will be charged.
*** ww w. **w..wxxxx *xxxxxxxxx * ** * * * * * * ** Fees ** *w * * ** * *rxxxxxxxx * * ** * wxx*xxxxxx * **
Permit Fee $ CCF $ 0 °0O Technology Fee: I .SO
Training /Education Fee $ n' C0 Notary $ 64 (10 Code Enforcement $
Double Fee $ Zoning $ Total Fee Now Due $ l VDO
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: �v
Drip Cap /Drip Edge:
Soffit:
Roof:
Flower Bins: 1
4
4
4
2
Shutters: ( 2 4
Awnings:
chimney: 1
Doors and Door Jams:
Garage Doors: 1
4
2
3
3
Fences: 1
All brick (simulated or regu arm
Stucco Banding
2 3
Any other Stt0ii j } rues: 1- 2 3
Accessory Buildings Other:
Attach color samples with name and
number.
C Ic
color
OWNER'S AFFI 'DAVIT: 1 certify that all the foregoing information is accurate and that all work will be done in
compliance with applicable laws regulating construction and zoning.
Signature
Owner or Agent
The foregoing instruments wits ackjaowledged before me this
day of tt( 20 . by .:142 -6 Aims
who is personally known to !tic or who has produced
GI`+ SZ 5270 As id Pnti fication and wh
NOTARY PUBLIC:
Sign:
Print:
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:
My Commission Expires:
APPLICATION APPROVE,) BY:
Plans Examiner
Preservation Board
Code ['Alibi-cement
(Revised 04 /24/0;