BP-02-1062iami Shores Villa
M
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
BUILDING
PERMIT APPLICATION
FBC 20
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Permit No. Z17°2— dCD2—
Master Permit No.
Permit Type: PAINT
OWNER: Name (Fee Simple Titleholder): L 1 S fF £ 4bJ 1 /3-) a Phone #: 954- 73. -S-OSs
13 / N +U .97. // - p,/ve:S - - 33 (19_2
Address:
City:
Tenant/Lessee Name:
State: Zip:
Phone #:
Email:
JOB ADDRESS: 16 6 A/ t 9 $ S 7,ad
City: Miami Shores County: Miami Dade Zip: 331
lI /-01- O7- -too t
Folio/Parcel #:
Is the Building Historically Designated: Yes , NO Flood Zone: AJQ
YO3
CONTRACTOR: Company Name: OttJN11.1;tor,yy {-7E3—/2._ Phone
Address: 13'30 / IV Li cc C 7
City: p6yuetrrier/ P,,J > State: Zip: '3 ?O2-)
Qualifier Name: Phone #:
State Certification or Registration #: Certificate of Competency #:
Contact Phone #: Email Address:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Description of Work: E`t;7rl/1 -p ki )triEl) Ii4 Via- .?W/S /S AIL/ 4 / /&Iv 7 14f7'
��
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 -pnor -.
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 * * * ** ******** * ** ** * * ***** ** :** * * **** * * ** x***
Permit Fee $ CCF $ Notary $ Training/Education Fee $
Technology Fee $ Double Fee $ TOTAL FEE NOW DUE $
FAINT COLOR APPROVAL AND AGPEMENT
All elements on the site must be listed and indicate the ncolor to be painted
4J o-ii A� 1 he�'P1 -! GIB -7t9N
DIRECTIONS: Please circle corresponding number to appropriate color sample.
Walls: 1 2 3 4
Fascia: 1 2 3 4
Drip edge: 1 2 3 4
Soffit: 1 2 3 4
Roof: 1 2 3 4
Flower Bins: 1 2 3 4
Shutters: 1 2 3 4
Awnings: 1 2 3 4
Chinmey: 1 2 3 4
Doors & Jambs:1 2 3 4
Garage Doors: '' 1 2 3 4
Railings: 1 2 3 4
Fences: 1 2 3 4
All Brick: 1 2 3 4
Stucco Bands: 1 2 3 4
Other Stucco
Feature: 1 2 3 4
Accessory Bldg: 1 2 3 4
Attach color sample with name and number
1.
2.
3.
4.
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 reg lating co struction and zoning.
Signature: M -�-R� T WW Signature:
AV'
w' • or Agent Contractor
The foregoing instruirlent was acknowledged before me this 2`�
day of /-11317 g-20 !fk-, by i t3 6f- C f\r7A >r(L
The foregoing instrument was acknowledged before me this
day of , 20 _, by
who is personally known to me or who has produced Ft / ' who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: ..�`�� �if��
/ NOTARY PUBLIC:
Sign: Sign: z.
Print: = o Print:
•My Commission Expires: ' %4Q' 'br•� My Commission Expires:
* * * * * * *** * **** * * ***** **** :**** * * * ***ai umWat * ** ******* * *** ***** ********** *****v:**** * * * * * ****a:**** * * ***
APPROVED BY: Code Official
Preservation Board