PT-10-922Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit No. Pr F 0 Ci
BUILDING
PERMIT APPLICATION
FBC 20
Master Permit No.
Permit Type: PAINT
OWNER: Name (Fee Simple / �/ Titleholder): a ( 071 1+,0,1 4 Phone #: �s/3 `75' — '% g
/
Address: g"7 P q f i rr''C st_
City: {' 0 1 i(/rrv1 i C X10 ((-p S State: Ft- Zip: .31/3
Tenant/Lessee Name: Phone #:
Email:
4P- re '
City: Miami Shores County: Miami Dade Zip: 3 3 I J r
Folio/Parcel #:
JOB ADDRESS:
x'78 A76/
Is the Building Historically Designated: Yes NO
Flood Zone:
CONTRACTOR: Company Name: fiG E- 6 Vint Phone #:
Address:
City: State:. Zip:
Qualifier Name: Phone #:
State Certification or Registration #: Certificate of Competency #:
Contact Phone #: Email Address:
Value of Work for this Per ' : $ ', \ iR1; -- Sq are/Linear Footage of Work: % (2 S f5
Description of Work: KO r`r � LS! IA
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 an inspection fee will be charged.
*, * * * * * ** * *** ** * * * * * *** * * * * * *** ** * * * ** Fees************* * * *, * * * * * * * * * *** * * * * * * * * *** ** **
Permit Fee $ CCF $ Notary $ Training/Education Fee $
Technology Fee $ Double Fee $ TOTAL FEE NOW DUE $
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 appr
Walls:
Fascia: 1
Drip edge: 1
Soffit: 1
Roof: 1
Flower Bins: 1
Shutters: 1
Awnings: 1
Chimney: 1
Doors & Jambs:1
1
Garage Doors:
Railings: 1
Fences: 1
All Brick: 1
Stucco Bands: 1
Other Stucco
Feature: 1
2
2
2
2
2
2
2
2 ('3
2
3
3
4
4
4
4
4
4
4
4
4
4
3
3 4
3 4
2
3 4
Accessory Bldg: 1
3 4
At
MUni- HRDDNI BISQUE
UL1 4-o -1 o"
/
number
OWNER'S AFFIDAVIT: 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: 1 )1LOLIA__)<— f7
Signature:
Owner or Agent _ Contractor
The fore ing instrument was « . s owledge
day 'L �i , 2010,b
who is . -rson. i ly known to me or who has produce
s identification and who 4ic
NOT Y PUBLIC:
The foregoing instrument was acknowledged before me this
day-9f
f
Sign:
Print:
My Commission Expires:
ff1111��
APPROVED BY:
) , by
' vheAs erscda y known to me or who has produced
L as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
, ' ° Print:
c•toc.- My Commission Expires:
Code Official
ctilkto
Preservation Board