PT-14-1155,j
Miami Shores Village {� r�I uN o RIM
4 2014 t
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 Nov I 1 I 1
PERMIT APPLICATION Master Permit No. 4
FBC 20
Permit Type: PAINT
OWNER: Name (Fee Simple Titleholder): "0143 co Phone#: (OQ (0
Address: t Q \ 0 Los:-
City: :_ (ilwi S(�. State:
Tenant/Lessee Name: Phone #:
Email: 6g ct Ioo_&CLp ._ M Q r�,e_d e. m
JOB ADDRESS: O'
City: Miami S!W res County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historicaff* Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: :!�O y fc f Phone #:
Address: � L 15 A.,- 3 ,J / of q
City: , d'e0. h State:
Qualifier Name: _) ' y �' > tEY L �P ('_ Phone #:
State Certification or Registration M C (2 6 S rj `� `7 Certificate of
� � �. Com enc 1� #: y
Contact Phone #: 6 Q Email Address: 2:9 04 50 y PM Qd e t ,119 C d
Value of Work for this Permit: $ Square/Linear Footage of Work:
Description of Work: n
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 A`I'ORNEY 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 certried copy of the
recorded notice of commencement Must be posted at the J ob site f or the f rst inspection which occurs seven ( 7 I days ti t
er the building permit is issued. In the absence o f
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 $_
i
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:
2
3
4
Fascia: 1
3
4
Drip edge: 1
,,
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
Chimney: 1
2
3
4
Doors & Jambs:1
3
4
Garage Doors: 1
2
3
4-
Railings: 1
2
3
4
Fences: 1
2
3
4
All Brick: 1
12
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 foregoing informa
applicable laws regulating construction and zoning.
Signature:
Owner or Agent
The foregoing instrument was acknowledged bef re this ° 0
day of , 20 LL�, b
who is personally Rnown lo me or who has produced
As identification and who did take an oath.
Attach color sample with name and number
1. uu Z 2 1 yCb�
2.
3.sw 6605 a k7s4-anr
4. i/� lea o0
tion is accurate and that all work will be done in compliance with all
Signature:
Contractor
The foregoing instrument was acknowledged before m thi s
day of t1 At . 20 �, by o / e 0 , 2
who i( personally knogto me or who has roduced
as identification and who did take an oath.
NOTARY PUBLIC: NOTARY C:
Sign. I I FRA Sign:
Print:
NOTARY PUBLIC Print: 8`
My Commission Expires: Can" EE219343 My Commis ion Ef 'q �1''t� #EE 1762I9
�EXPIIkI41AR. 06, 2o18
E)OM
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* * * *�
APPROVED BY: �-- Lt "t Code Official
Preservation Board
SW 7006
Extra White