PT-07-2172BUILDING
PERMITAPPLICATION VICM Master Permit No.
FBC 2004
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305)/795)2204 Fax: (305) 756.8972
)Q 29 01 Permit No. 1` IO ' 2- 11 Z .
Permit Type: PAINT PERMIT
Owner's Name (Fee Simple Titleholder)
Owner's Address
City
Tenant/Lessee N.,me
E -MA L: C
4-/UP
0
State
Phone #
Zip 33 /g
Phone #
A92 - G9
,DECD
County ' Miami -Dade.
Job Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL #
Zip
Is Building Historically Designated YES
Contractor's Company Name
Contractor's Address
Phone #
1-17 r-
City State ZiP
Qualifier Name
Phone #
State Certificate or Registration No. Certificate of Competency No.
OWNER BUILDER:
Value of Work For this Permit $ OC)C) T
Describe Work:
pe of WoRlc: ddition / ❑ Alteration / ['New /Repair /Replace
Application is hereby made to obtain a pert 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 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 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: . fs cr condition to the issuance of a building permit with an estimated value exceeding $2500. the applicant must promise in good faith that a cola of the
notice of commencement and construction lien law brochure. mill 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 job site for the first inspection which occurs seven () 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 he charged.
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Permit Fee $ ' CCF $ V Technolo Fee:
Training /Education Fee $ 0 , Notary $ S'00 Code E
Double Fee $
Zoning $ Total Fee Now
See Reverse side -
MIAMI SHORES VILLAGE
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.
W al l s:SW
Fascias (Yb / 3 4
Drip Cap /Drip Edge: 1 2 3 4
Soffit: 1 2 3 4
Roof: I 2 3 4
Flower Bins: 1 2 3 4
Shutters: 1 2 3 4
2 3 4
3 4
ey 3 4
3 4
3 4
Fences: 1 1 2 3 4
Awnings: I
Chimney: l
Doors and Door Jai is:
Garage Doors: I
Railincs: l
AM brick (simulated or regular):
Stucco Banding:
l
3
Any other Stucco Features:
Accessory Buildinms
Attach color samples with name and
cumber.
51,1)
s
OWNER'S AFFU AVIT: I certify that all the foregoing information is accurate and that all work will be done in
compliance wit( al applicable laws regulating construction and zoning.
Signature
Own or Agent
The foregoing instrument waft acknowledged before me this ZS-
The foregoing instrument was acknowledged before me this
day of " 20 01:
Signature
Contractor
Y 1�1 rOs0
day of . 20 . by
who is personally : rwn to the or who has produced who is personally known to me or who has produced
As identi hc:ation an io did take an oath. as identification and who did t`nke an oath.
.��YpUB71GSTA NOTARY PUBLIC:
NOTARY IIBL(C ,� •.
sign: "s.�4►: ��
"Labe] ��ign:
so Pines: 17917- Print.
Print: 13, 20
My Con issian Expires: cBO ".,u\c;�•�y .1 My Commission Expires:
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APPLICATION APPROVE
BY:
Plans Examiner
Preservation Board
Code Enforcement
(Revised 04/24/0-i