PT-13-0043Miami Shores Village PECEIVED
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 " — `- ---
` 3
BUILDING Permit No. �Ti3
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: PAINT
OWNER: Name (Fee Simple Titleholder): -,-/C (�L Su u— _ Phone #: 305" 3/0 5 /7j�
Address::, t1 /D/ ST
City: /�',4.,, State• Zip:3� /�
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS:
City: MiaMi Shores County: Miami Dade Zip: 3�
-------/ 5
Folio/Parcel #:.Z bT /S- 4 CK, O 4,? /7 BL K
Is the Building Historically Designated: Yes NO Flood Zone:
. �11
CONTRACTOR:
C me Phone #�� �n
Address: 14
OPP-
City:inPr / j� I
�/ 'E ock State: 4. Zip: MOO c r
Qualifier Name: in A , Phone#: 27.7 —u 7W
State Certifica ' Registration #: Certificate of Competency #:
Contact Phone., Email Addresu
Value of Work for Square/Linear Footage of Work:
Description of Works
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,..WI1S, POOLS, FURNACES, BOILERS,
HEATERS, TANKS and AIR CONDITIONERS, ETC.....
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCE MAY RESULT IN YOUR PA *,-- TWICE FOR
IMPROVEMEN r PTO, YOUR PROPERTY. IF YOU TO UBTAIN
FINANCING, CONSULT, WITH YOUR LENDER OR AN NEY B EFORE
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 mkf�romise 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 $
4
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:
3
4
Drip edge: 1
("F)
3
4
Soffit: 1
3
4
Roof: 1
2 a
3
4
Flower Bins: 1
°''
3
4
Shutters: 1
3
4`
Awnings: 1
Chimney: 11
-�
X 2
'
,
Doors & Jamt ,� 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
OWNER'S AFFIDAVIT: I certify that all the f regoing information is accurate and that all work will be done i o Hance with all
appli aw regulating con tructi an onin
Signatur . Signature:
er or A pS �.�p d ontraor
The foregoing instrument was acknowledged before me this 77 opgoing instrument wa ackeow%dg d before me this
day of A'e- It— , 20 AL b da 20 by e- iq ft�
d
who is personally kno *6 who produced who is pe onally known to me or a p duced
5k,01e g2lb N66
idriicatio who did take an oath. a ' `co�hFa1°nd who °d take an oath.
NO
It r peb oR`''�"� 206 OA
xP`
sign: Si
Print: (t Pri 1
My Commission Expia My Com ires:
APPROVED BY: Code Official
Preservation Board