RT-13-1801Miami Shores village -
Building Departments
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 _ J
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949 Q 1
BUILDING Permit No.
PERMIT APPLICATION Master Permit No. 97 $
FBC 20
Permit Type: PAINT T -L uc.
OWNER: Name (Fee Simple Titleholder): eZS4 t>etTi4L )A6W-- 1ZJ Phone#: c164- gg 3-- 607
7
Address: ipW 9904" 514 t-1.1_ / o -!T
City: E' --A I Qft % StO'ev--S State: L. zip: S3 1 3P,
Tenant/Lessee Name: O Phone#: /
Email �L-p��-i'� �- P�tcL►+e.p�7�; y,v-� C,0- Cos. -
JOB ADDRESS: �2q q take. k1R-0' ST
City: Miami Shores County: Miami Dade zip: 3 3 130
Folio/Parcel#:
Is the Building Historically Designated: Yes
NO x Flood Zone: I -\-
CONTRACTOR:
CONTRACTOR: Company Name: ��L.S*-tc0ESi.�ab,T, 1 NC- Phone#:
Address: Ski rAlf- ) o S -r
City: V-Ao �-t Sow ez-s —State: Zip:
Qualifier Name: Phone#:
State Certification or Registration #: 5 �3'r]Oq Certificate of Competency #:
Contact Phone#: Email Address:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Description of Work: e_yTc7 a i cz o- l�s�, �.►
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, 4hat all work will be performed to meet the standards of all laws xgulating..construction in this jurisdiction. I
and?ritand that a separate permit must be secured for ELECTRICAL WORI{, WUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS,
HEATERS, TANKS and AIR CONDITIONERS, ETC.....
"WARNING TO, OWNER: YOUR FAILURE • TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT INYOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH 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 fust 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 $
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:
2
3
4
Drip edge:
2
3
4
Soffit: 1
2
3
4
Roof: 1
2
3
4
Flower Bins: 1 2 3 4
Shutters:
Awnings: 1 2 3 4
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:
Stucco Bands: 1 2 3 4
Other Stucco
Feature: 1 2 3 4
Accessory Bldg: l 2 3 4
Attach color sample with name and number
1.co
O H
o
C
�Q
2.
3.
4.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work
applicable laws regulatin construction and zoning.
Signature: Signature:
or or Agent
be done in compliance with all
7= The foregoing instrument was acknowledged befo a me this 7�
The foregoing instrument was acknowledged before me this g ' g g ;
day of L 14S -f 20 L3, by�-Oxha laz) Qlat jY , day of A� ZO L3, by
who is personally known to me or who has produced who is personally known to me or who has produced
As identi�and yYhQ did take an oath. _ _ as identif6U6aa= who did take an oath.
NOTARY P BLIC:
i
NOT
Sign:
Print:
My Commission Expires: /0)Q51-2015
APPROVED BY: Code Official
Preservation Board