PT7-964 o5hj lu-h = Miami Shores Village
Building Department
artment
p
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
'T55:-n071 F (305) 756.8972
71 I(A
BUILDING 0 2 Permit No.
MAY 1
PERMIT APPLICATIO M ------- Master Permit No.
FBC 2004 BY:--------
Permit Type: PAINT PERMIT
Owner's Name(Fee Simple Titleholder) (��(� �w� "� hone#
Owner's Address ?D(-;
City k�m State � Zip 'J 3 I t>
Tenant/Lessee Name Phone#
E-MAIL:
Job Address(where the work is being done) 3 ke "t L S
City Miami Shores Village County Miami-Dade Zip 3�
FOLIO/PARCEL#
Is Building Historically Designated YES NO
Contractor's Company Name DIAVLQA Phone#
Contractor's Address
City State Zip
Qualifier Name Phone#
State Certificate or Registration No. Certificate of Competency No.
OWNER BUILDER:
i
Value of Work For this Permit$ Type of Work: ❑Addition/ ❑Alteration/ ONew/❑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$2500,the applicant must promise in good faith that a copy of the
notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice
of commencement must be posted at the job site for the first inspection which occurs seven(7)days after the building permit is issued. In the absence of such posted notice,the
inspection will not be approved and a reinspection fee will be charged.
******** ***************************Fees*****************************t***************
Permit Fee$ O qv
CCF$ Technology Fee: I-
Training/Education Fee$ Notary$ 'Q� Code Enforcement$
Double Fee$ Zoning$ Total Fee Now Due$
i JUN 1 TIM erse side--+
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+w 3 4 Attach color samples with name and
Fascia: 1 2 3 4 =Y
Drip Cap/Drip Edge: 1 2 3 4
Soffit: 1 3 4 1
71OC-2
Roof- 1 2--3— 4 Raffia Cream
Flower Bins: 1 2 3 4
Shutters: 1 2 3 4
Awnings: 1 2 3 4 2
Chimney: 1 2 3 4
Doors and Door Jams: 1 3 4
Garage Doors: 1 2 4
Railings: 1 2 3 3
Fences: 1-2-3—
All
23All brick(simulated or regular): 1 2 3 4
Stucco Banding: 1 2 3 4
Any other Stucco Features: 1 In 3 4 4
l.31N7V e
K 'C .
Accessory Buildings Other: Q
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 �—�C�_ Signature
Owner or Agent Contractor
The foregoi instrument was acknowledged before me this �D The foregoing instrument was acknowledged before me this
day of 20Q ,by d*11% COtT day of ,20_,by ,
who is personally known to me or who has produced ye �✓G who is personally known to me or who has produced
6?,Iy As identification and who did t oath. as identification and who did take an oath.
NOTARY P NSS �\A�'g95 NOTARY PUBLIC:
P �� 2 a
Sign: MON�c�gS�N X20, Sign:
. P
Print: dX�CG M xQ�RE ,N Print:
My Commission Expires: ' •....F°`. My Commission Expires:
APPLICATION APPROVED BY: Plans Examiner
( Preservation Board
,1 \J1 Code Enforcement
(Revised 04/24/07)
Permit No. PT.-S-07-964
�s@°Rns y Miami Shores Village Permit Type.Paint
�,. 10050 N.E.2nd Avenue
Work Cfass lkatran New
_r
Miami Shores,FL 33138-0000 e Permit Status:APPROVED
, Phone: (305)795-2204
sue Ire:511712007 Expiration: 11/1312007
Project Address Parcel Number Applicant
353 NE 91 Street 1132060136520 %r
ROBERT NELSON
Miami Shores Village, FL Block: Lot:
Owner Information Address Phone Cell
ROBERT NELSON 353 N. E.91 ST.
Contractor(s) Phone Cell Phone i $ 1,000.00
HOME OWNER I Valuation:
Total Sq Feet: 0
Type of Work:Exterior Available Inspections:
Color:RAFFIA CREAM/HARVEST BROWN/BISON BR knal
nspection Type:
Additional Info:
Classification:Residential
Color: RAFFIA CREAWHARVEST BROW WBISON Code Comments:BEHR-WALLS-RAFFIA CREAM
Color: RAFFIA CREAM/HARVEST BROWWBISON Color:RAFFIA CREAWHARVEST BROWWBISON
Fees Due Amount Total Amt Paid I Amt Due
CCF $0.60 -•
Education Surcharge $0.20 $0.00 $0.00
Notary Fee $5.00
Permit Fee $60.00 Payment Type: 7 ���
Technology Fee $1.50 /2
Total: $67.30 J4.
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.
May 17, 2007
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
Thursday, May 17, 2007 1
Receipt
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000
Phone: (305)795-2204 Fax: (305)756-8972
Permit Number: PT-5-07-964 Owner Address:
Invoice Number: PT-5-07-28444 353 N. E. 91 ST.
Applicant: ROBERT NELSON
Company Name:
Job Address:
353 91 Street NE
Miami Shores Village, FL
Date Payment Type Check Number Amount Change
Tuesday, June 12, 2007
06/12/2007 Check 3269 $67.30 $0.00
Total Payment: $67.30
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