PL-13-2174.ti
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 APPLICATION
FBC 20
Permit Type: PAINT
Permit No.
Master Permit No. `
OWNER: Name (Fee Simple Titleholder): Mindy Mcllroy Phone#: 305) 970 -6344
Address. 739 NE 74th Street
City: Miami Ste. FL Zip: 33138
Tenant/Lessee Name: Phone#:
JOB ADDRESS: 127 NE 97th Street
City: Miami. Shores County:
Folio/Parcel #:
Is the Binding Historically Designated: Yes NO Flood Zone:
33138
CONTRACTOR: Company Name: MG Deco Painting, Inc. Phone#: (305) 588 -8041
Address: 199 SW 12 AVE #420 _
City: Miami State. FL
Qualifier Name: Uvania Galagarza
State Certification or Registration #: Certificate of Competency #:
Contact Phone #: Email Address: mgdecopainting @yahoo.com
Value of Work for this Permit: $,2,000 Square/Linear Footage of Work: _
Description of Work: Paint exterior and roof of house etkw6,I
33130
(305) 903 -7156
07BS00736
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 WITFI 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. /n the absence of
such posted nouce7 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 $
R PAINT COLOR APPROVAL AND AGREEMENT
Al elements on the site must be listed and indicate the color to be Bainted
DIRECTIONS: Please circle corresponding number to appropriate color sample.
walls: 1 A
2
3
4
Fascia: 1 X
2
3
4
Drip edge: 1 i`
2
3
4
Soffit: 1
2
3
4
Roof: 1
2
3
4
Flower Bins: 1
2
3
4
Shutters: 1
2
3 X
4
Awnings: 1
2
k 3 X
4
Chimney: 1
2
3
4
Doors & Jambs: 1
2
Y• 3 X
4
Garage Doors: 1
2
3
4
Railings: 1
2
3
4
Fences: 1
2
3
4
AIR Bride 1
2 3 4
Sun �ars ill
Other Stucco
2 � 3 4
Feature: 1
2 3 4
Accessory Bldg: 1
2 3 4
Attach color sample with name and number
.L
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 regulating construction and ning.
Si Signature:
Owner or Igent Contractor
The foregoing instrument was acknowledged befo Me this J foregoing instrument was acknowledged before me this!
day of i , 20 �, by of 5o0s2nM . 20 13, by t k(An1 O D- tr-! Q ` , �VOG
o is personally kn to me or who has produced is personally known to me or who has produced Ci Y iV
As identification and who did take an oath.
NOTARY UBLIC:
Si
Print:
My Commissi Expires:
APPROVED BY:
identification and who did take an oath.
too
NOTARY PUBLIC:
5 Sign.
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2015 Print:�� S G►�' 1 ��,1'1 C7
My Commission Expires: A APLICANO
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a�ea�e�.x.aee ses�e,x 15, 2018
Preservation Board