PT-07-2176Miami Shores Village O19.407
Building Department QiJ°""I"g
10050 N.L.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING RECE Permit No. -1 _ 211 r
PERMITAPPLICATION Master Permit No.
FBC 2004 BY
Permit Type: PAINT PERMIT
Owner's Name (Fee Simple Titleholder) A
f}1(Z/ZO SU fl t2 Z Phone #(00`51) 589— 3-9133
Owner's Address
. go q.9 s
City J- IR1-.1— '/®t S State Zip 53/s O
Tenant/Lessee Name Phone # 08.6>
E -MAIL: 6(34412E2_ ?fA Leo a 'c0A-/
Job Address (where the work is being done)
SAk
City Miami Shores Village ( ' County iami -Dade Zip
■ �i f ! r
FOLIO / PARCEL # 1 -7! 1�
Is Building Historically Designated YES NO y
Contractor's Company Name D W iii A Phone #
Contractor's Address
City
Qualifier Name
State Certificate or Registration No. Certificate of Competency No.
State
Zip
Phone #
OWNER BUILDER:
Value of Work For this Permit $
Describe Work:
04,0te-
A >lication is hereby made to Main a liennit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit
PI Y
and that all work will he performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured fi r
ELECTRICAI. 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 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 in good faith 111(11 11 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 he posted at the joh'she 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 he charged.
//e: atxxxxxxxxz&x *x w*** xxrxxxxx drxx oYx *xx***Fees***x *xxxxk******** Y****x*'****xxxxx *xxBexxxxxa
Permit Fee $ (.Q 0 62).*-- CCF $ a 00 Technology
Training /Education Fee $ -C) Notary $ 5 .a) Code Enf
ES
Type of Work: ❑ Addition / ❑ Alteration / ['New / ❑ Repair /Replace
o c
Double Fee $
Zoning $ Total Fee Now Du
cK1to
MIAMI S! "r.7GV�
See Reverse side —
PAINT COLOR APPROVAL AND AGREEMENT
AU 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
Soffit:
Roof:
2
Edge:
2
4
4
3
4
Flower Bins: l
4
Shutters:
Awnings: 1
Chimney:
2
'2
Doors and Door Jags:
Garage Doors: 1
Railings:
Fences:
4
4
4
3 4
;? 3
3
3 4
All brick (simulate or regular): ! 2 3 4
Stucco Banding: 1 2 3 4
Any other Stucco Features: mil(
Accessory Buildings
Other:
Attach color samples with name and
number.
OWNER'S AFF A r • certify that all the foregoing information is accurate and that all work will be done in
ulating construction and zoning.
The foregoing instrument di ack},owledgeddJ��before me this +td9
day of dLT . 20 d t. ��Y /G1Kit'i lTdl�lr0 Ueyec..,
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of
20 .by
who is personally known to �e or who has produced P who is personally known to me or who has produced
As identification and who di . l�tl \. as identification and who did take an oath.
NOTARY PC
Sign:
Print:
My Commission Expires:
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
*r. ** * * * * * * * * * * * * * * * * *xx "`xxxxxx * * *xxx . ***************%t xxxxxoY gtr+Y************** *.**4:kdc***********************
APPLICATION APPROVE) BY:
Plans Examiner
Preservation Board
Code EnForcement
(Revised 04/24/01