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PT-13-1099 XOM21vx] Miami Shores Village [ MAY 17 2013 �• �I� Building Department p 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY.ma®omo........0.0000 Tel: (305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 BUILDING Permit No.07) -- IC09 PERMIT APPLICATION Master Permit No. FBC 20 Permit Type:PAINT �805' ZY6 0 Y 7 OWNER:Name(Fee Simpll Titl ]der): Vl le00,0-414Phone#: J © —/J&a a�// Address: / I �f'b1 /°(u City: P d rQ S State: Zip: / Tenant/I.essee Name: Phone#: Email: Igt9r1 Wl QAA IqS 3 n e c JOB ADDRESS: 2717 1,d4-k v� City: Miami Shores County: Folio/Parcel#: / Is the Building Historically Designated:Yes NO V0 Flood Zone: CONTRACTOR:Company Name: 14(ym -0 Phone#: Address: City: State Zip: Qualifier Name: Phone#: State Certification or Registration#: Certificate of Competency#: Contact Phone#: mail Address: Value of Work for this P t:$ 9-1 SadArefilridar Foo a of Wo k: Description of Work: 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 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$2500,the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a cert{f`ted copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven(7)days after the building permit is issued. /n the absence of such posted notice,the inspection will not be approved and an inspection fee will be charged x�x��xxxmx��xx�x��x��x+xx��x•x��x�xx�x�Fees+x��+xx��xx�xx�x��x+x�m��x��m��x Permit Fee$ 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 A 2 3 4 Fascia: 1 2 3 4 Attach color sample with name and number Drip edge: 1 2 3 4 1. Soffit: 1 2 3 4 Roof: 1 2 3 4 Flower Bins: 1 2 3 4 Shutters: 1 2 3 4 2. Awnings: 1 2 3 4 Chimney: 1 t 2 3 4 Doors&Jambs:1 2 2 3 4 Garage Doors: 1 2 3 4 3. Railings: 1 2 3 4 Fences: 1 2 3 4 All Brick: 1 2 3 4 Stucco Bands: 1 2 3 4 4. Other Stucco Feature: 1 2 3 4 Accessory Bldg: 1 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. n R I Signature: Signature Owner or Agent Contractor The foreg trume.�A�as a owledgeo befor 1�� The foregoing instrument was acknowledged before me this day o ,20!�/ by �V- day of ,20_,by , pe s�D.5,ns nallykn to me or who has produced ho is personally known to me or who has produced identification and who di t as identification and who did take an oath. NOTAR PUBLIC: AUDIA v.GUB1U-OS NOTARY PUBLIC• SOP-o123o2015 9 xPires Sep r• ' M r on#F-f MIR"Assn• Sign: Sign: Bonded Print: ��4q iT``, Print: My Commission Expires: My Commission Expires: APPROVED BY: Code Official Preservation Board