PT07-1215 Miami Shores Village -
Building Department JUN 1 1 2007
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305) 7952204 Fax: (305) 756.8972 [.i Y:----
BUILDING Qco I rilm Permit No.P0-1— 12.1
PERMIT APPLICATION Master Permit No.
FBC 2004
Permit Type: PAINT PERMIT 7
Owner's Name(Fee Simple Titleholder) Zj / Phone# 306- 7S'
Owner's Address ,6
City Mi 4,09i `ShQ/'Pf State FL Zip 4 31 P
Tenant/Lessee Name Phone#
E-MAIL:
Job Address(where the work is being done) Jy NL... lln6
City Miami Shores Village County Miami-Dade Zip
FOLIO/PARCEL#
L Building Historically Designated YES NO
Contractor's Company Name W�1�.(� Phone#
Contractor's Address
City State Zip
Qualifier Name Phone#
State Certificate or Registration No. Certificate of Competency No.
OWNER BUILDER: Sev urn Z I IYES/NO
Value of Work For tJh s Permit$ loco JI Type of Work: ❑Addition/ ❑Alteration/ []New/❑Repair/Replace
Describe Work: r a r....-x4er-/O/'
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 secur@d 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$2500,the applicant must promise in good faith that a copy of the
notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of theecorded notice
of commencement must be posted at the job site for the first inspection which occurs seven(7)days after the building permit is issued. /n the absence of such pos d notice,the
inspection will not be approved and a reinspection fee will be charged.
i
Permit Fee$ 0 �� ' CCF$ Technology Fee: (c)-ogn
Training/Education Fee$_ ron Notary$ — Code Enforcement$
Double Fee$ Zoning$ Total Fee Now Due$ I'ot
See Reverse side-�
I �
PAINT COLOR APPROVAL AND AGREEMENT
All elements on the site must be listed and indicate the color to be painted
Directions: Please:72
corresponding number to appropriate color sample
�jwalls: - R 1 3 4 Attach color samples with name
--njFascia: 2 33 4 and number.
Drip Cap/Drip Edge: 1 2 ( 3 ) 4
1.,7�ffit: 1 ( Z 1 3 4 1 _
SW 6163
lrlecB iris:_1 2 3 4 'ROUSE Grassland
SkeFS 1 2 3 4 —
._�jAwnings: 1 2 3 4 Z
.—jChimney: Cl 2 ° 3 4
SW 6161
Doorran-d-Do—Dor Jams: 1 2 4 Nonchalant White
,Garage Doors: 1 2 3 4
pigs: 1 2 3 4 3;
Pees: 1 2 3 4
AN-bridrTsimulated or regular): 1 2 3 4
Stucco—Banding:-1— 2 3 4 _-
-nrr-n pother Sweee-Features: 1 2 3 4 4
Aescssory Building Other:
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
O er or
Agent// Contractor
The fore oing instrument was acknowledged before me this ( The foregoing instrument was acknowledged before me this
day of� ,20_,by , day of 120_,by ,
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY NOTARY PUBLIC:
Sign: Sign:
Print: Print:
My Comm ssion Expires: My Commission Expires:
APPLICATION APPROVED BY: Plans Examiner
/ Preservation Board
Code Enforcement
(Revised 04/24/07)
T-6-07-'t 215
`SNoREs y Miami Shores Village P#ii Tom.Palo
10050 N.E.2nd Avenue
tNoi'I€C1assatictn New
Miami Shores,FL 33138-0000 permit
SIN-
Phone: (305)795-2204ii ttimAPPROVED
�`OR1Dp Ex Iration: 12/09/2007
Project Address Parcel Number Applicant
._............,_,,,,,,_ _....................
358 NE 100 Street 1132060135430
BEVERLY MUZII
Miami Shores Village, FL Block: Lot:
Owner Information Address Phone Cell
_ BEVERLY MUZII 358 NE 100 ST
MIAMI SHORES FL 33138-2421
.j
_.............
Contractor(s) Phone Cell Phone Valuation: $ 1,000.00
HOME OWNER Total Sq Feet: 0
Type of Work:Exterior Available Inspections:
Color:grassland/nonchalant white Inspection Type:
Additional Info:
Final
Classification:Residential
Color:grassland/nonchalant white—Approved Code Comments:SHERWIN WILLIAMS-WALLS-
Color:grassland/nonchalant white_Approved_ Color:grassland/nonchalant white—Denied
Fees Due Amount Total Amt Paid Amt Due
CCF $0.60
Education Surcharge $0.20 $0.00 $0.00 $ 0.00
Notary Fee $5.00
Permit Fee $60.00 Payment Type:
Technology Fee $1.50
Total: $67.30
,SUN PAID
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 12,2007
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
Tuesday,June 12, 2007 1