RC-13-273 Miami 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
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.
FBC 20 1�
rmit Type:PAINT
OWNER:Name(Fee Simple Titleholder):_ Phone#: q2D 20 643CI
Address:_1 I q. 1111z ID S__
City:-no]G< lf,�Oo q e-s State: f Zip: l
Tenanta essee Name: Phonek
Email: CIM U Le.rXn o, Z q(a V)CJD (Y-1
JOB ADDRESS: 9 I t-e I +n S+
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated:Yes ( NO 1 Flood Zone:
CONTRACTOR:Company Name: #:
ne,a, Phone
Address: l I�-y1 10 W-r f'1 55+
a
City: ry)i SVI 0 Ir —State: ta—° zip:-3 l (o
Qualifier Name: Phonek
State Certification or Registration#: Certificate of Competency#:
Contact Phonek Email Address:
Value of Work for this Permit:$ Square/Linear Foota a of Work:
Description of Work: G(t r >T ��j M t op—, f� � ' 6,00e, rACt U13 I el (A)IS
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$2500,the applicant must promise in good faith that a copy of
the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the
recorded notice of commencement must be posted at the job site for the first inspection which occurs seven(7)days after the building permit is issued. In the absence of
such posted notice,the inspection will not be approved and an inspection fee will be charged.
Permit Fee$ CCF$ Notary$ Training/Education Fee$
Technology Fee$ Double Fee$ TOTAL FEE NOW DUE$
It
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: 1_ 2 3 4
Fascia: \1 2 3 4 Attach color sample with name and number
Drip edge: 1 2 3 4
Soffit: 1 2 3 4
Roof: 1 2 3 4
� 1
Flower Bins: 1 2 3 4
Shutters: 1 2 3 4
Awnings: 1 2 3 4 2.
Chimney: 1 2 3 4
Doors&Jambs:l 2 3 4
Garage Doors: 1 2 3 4
Railings: 1 _ 2 3 4 3.
Fences: 1 2 3 4
All Brick: 1 2 3 4
Stucco Bands: 1 2 3 4
Other Stucco 4.
Feature: 1 2 3 4
Accessory Bldg: 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 law gulating construction and zoning.
Signature: Signature:
O � Agent Contractor
The foregoin instrument was acknowledged before!me this n Y The foregoing instrument was acknowledged before me this
day of ,20 13 by nk day of .20—,by
who is personally known to me or who has produced Uj::) who is personally known to me or who has produced
As identification and who 0d*4 HN,94th, as identification and who did take an oath.
NOTARY PUBLIC: �.``� LS• •••. ''�, NOTARY PUBLIC:
a
Sign; _ `may' �°xi - Sign:
Print: ''• —°�•5'a,=,.r'� Print:
My Commission Expires: ,, •' ```��` My Commission Expires:
APPROVED BY: Code Official
Preservation Board