PT-11-1559PAINT 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:
2
3
4
Drip edge: 1
2
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: l
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
Attach color sample with name and number
W)
3.
4.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all rk will be done in compliance with all
applicable laws regulatin corftrction and zoning. f/
I \ !1
Signat Signature: v
Ow er Agen I n � Contractor
The fo of instrume was a o 1 re me t i A The for i instrument was ackn le ged bef e
day o 20�� , b n da of , 20�, b
Y Y Y
/-31/�, o is ersonally known to me or who has produced who is )ersonally known to me or who has produce 2,
I I As identification and who did take an oath. I �j as identification and who did ke an oath.
NOT AR UBLIC: NOTA Y BLIC:
Sign: 4 ��''y Sign:
NV
Print: a Print: �\
n iv
i'
M Commission Expires: 01 M Commission Ex Tres .,�
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APPROVED BY: �4 aoU Code Official
Preservation Board