PT-07-1111�� yt6ORf$
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Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Issue Date: 6/11/2007
Permit No. PT -5-07-1111
Permit Type: Paint
Work Classification: New
Permit Status: APPROVED
Expiration: 12/08/2007
Contractor(s) Phone Cell Phone
HOME OWNER
Type of Work: Exterior
Color:
Additional Info:
Classification: Residential
Color: _Approved
Color: _Approved_
Valuation: $ 1,000.00
Total Sq Feet: 0
Code Comments: WALLS - LIGHT GREEN/GREY /
Color: _Denied
Fees Due
Amount
CCF
$0.60
Education Surcharge
$0.20
Notary Fee
$5.00
Permit Fee
$60.00
Technology Fee
$1.50
Total:
$67.30
Total Amt Paid Amt Due
$ 0.00 $ 0.00 $ 0.00
Payment Type: 0k u) q
3 rA
Available Inspections:
Inspection Type:
Final
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore, I authorize the above-named contractor to do the work stated
June 11, 2007
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Monday, June 11, 2007 1
Miami Shores Village
►�o i arAsuk-r Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
T l• (305) 795 2204 Fax• (305) 756 8972
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: PAINT PERMIT
Owner's Name (Fee Simple Titleholder)
Permit No.
aster Permit No.
-------------
Phone
_ -- --
Phone # 3 o, � � 54 o 1'
Owner's Address "'l p A),) ry W �k C-09—
city P �, (� State r 2-
I Zip 3 /S 0
Tenant/Lessee Name
E-MAIL
Phone #
Job Address (where the work is being done) (' y 6& j& c M pd teo f ee'Ft -L ��t%O i'✓l.(% `� /� �.Q
City Miami Shores Villagg County Miami -Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES NO
Contractor's Company Name _ C(-046/— Phone #
Contractor's Address
City
Qualifier Name
State Certificate or Registration No.
OWNER BUILDER:
State
Zip
Phone #
Certificate of Competency No.
Value of Work For this Permit $ —o K1f7 , Type of Work: ❑ Addition / ❑ Alteration / ❑New / ❑ Repair/Replace
Describe Work:
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 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. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Permit Fee $ w CCF $ f K/® Technology Fee: I . 5d
Training/Education Fee $ - Notary$ 5 00 Code Enforcement $ 2 C,
Double Fee $ Zoning $ Total Fee Now Due $ C2-7 `�J UN f
See Reverse side -a
PAINT COLOR APPROVAL AND AGREEMENT
All elements on the site must be listed and indicate the color to be painted
t
Directions: Please circle corresponding number to appropriate color sample.
Walls: 1 2 3 4 Attach color samples with name and
Fascia: 1 2 3 4 number.
Drip Cap/Drip e: 1 2 3 4
Soffit:
2
3
4
1
2
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 and Door Jams: 1 2 34
Garage Doors: 1 2 3
4
Fences: 1
All brick (simulated or
Stucco Banding
Any other Stucco Featt
Accessory Buildings _
0a
99
Other:
OWNER'S AFFIDAVIT: I certify that all the foregoing in
compliance with all applicable laws regulating construction
3
0
Fn
that all work will be done in
Signature Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of %(, 2oDYb
, by ' r�g�Gy ( day of 20 _, by
who is personally known to me or who has produced / / who is personally known to me or who has produced
u., . As identification and who did take an as identification and who did take an oath.
NOTARY �- n ANO\ NOTARY PUBLIC:
Sign: uss 00 9 �5 Sign:
Print: Utt{!� 1 .91st+ M �MsSS ��obet\G��ae�+ Print:
My Commission Expires:
My Commission Expires:
APPLICATION APPROVED BY: Q O Plans Examiner
Preservation Board
r
fCode Enforcement
(Revised 04/24/07)