PT-13-745Miami Shores YMage APR 1 f 2613
Building Department BY.- .�--:-
10050 N.E.2nd Avenue, Miami Shores, F1orida33138 .
Tel: (305)'795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: lum IQA949
Or
BUILDING Penult No.
PERMIT APPLICATION Master Permit No.
FBC- 20
Permit Type: PAINT
OWNER: Name (Fee Simple Titleholder): 11>917- Koutre--�c y Phone# Or 4V
Address: 914 V ✓V tal r'
City: �� i S 409,6—$ State: L Zip: f O
t
Tenant/Lessee Name: Phone#:
Email• Id�rpL L(9 a"Aotn
JOB ADDRESS: �M+O' W.
City: Miami Shores County: Miami Dade
zip: Saiz..
Folio/Parcel#:
Is, the Building Historically Designated: Yes NO Flood Zone:.
CONTRACTOR: Company Name:
Phone#',
Address:
City: State: Zip;
Qualifier Name:Phone#;
State Certification or Registration #: Certificate of Competency #:
Contact Phone#: mail Address:
Value of Work for this Permit. $ 1 Square/Linear Footage of Work:
Description of Works 16 103 O'F 41P(xS�
Application is hereby made to obtain a permit to do the work and installations as indicated. i certify that no work or installation' "has eptti E i prior
to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction ithis: jurisdkfm. I
understand that a separate permit must be secured,for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, r UitrltR Es; Bgl1.ERS,
HEATERS, TANKS and AIR CONDITIONERS, ETC.....
"WARNING TO OWNER: YOUR FAILURE I TO RECORD A NOTICE-,, OF
COMMENCEMENT
MAY RESULT IN YOUR PAYING TVVhCE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OETAT
FINANCING, CONSULT WITH YOUR LENDER OR AN ATT6RNXk:,1#A
FORE `
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2300,, the applicant mast ptntnise in 800040 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 re►nfied copy of the
recorded notice of coihmencement must be posted at the job site for the first inspection which occurs seven (7). days after the building permit is iss6e4: ' in fibs a8"sewe 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 $
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
Drip edge: 1
2
3
4
4
Soffit: 1
2
3
4
Roof: 1
2
3
4
Flower Bins: 1 2 3 4
Shutters:
Awnings:
Chimney: 1 2 3 4
Doors & Jambs: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
Attach color sample with name and number
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 zoning.
Signature: Signature:
CZ Y Owner or Agent { Contractor
The for oift' instrument was ac npwledge
(e'fore me this I I The foregoing instrument was acknowledged before me this
of 20 f � b '"-� �' i da of 20 b
day 1�, Y Y Y
who is p onal�y known to me or who has produced who is personally known to me or who has produced
(64 - 4s identification and who did take an oath. as identification and who did take an oath.
NOTA Y P BLIC: NOTARY PUBLIC:
A V C!iR!LLOS
o. u - S! to of Florida
Sign: �,� M F ores Sep 23, 2015 Sign:
Print: Bontlpd Through National Notary Assn_ Print:
My Commissi n Expires: My Commission Expires:
APPROVED BY: `SA15 Code Official
Preservation Board