PT-14-1447 Miami Shores Village E -,
Building Department JUL072014
DD
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 $Y�
I Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 2010
PAINT Master Permit No.'E/ 6e' A/4/72--
PERMIT APPLICATION Sub Permit No.
JOB ADDRESS: ® 4 � I/
City: Miami Shores County: Miami Dade Zip: -S l
Folio/Parcel#: Is the Bu Iding Histori ally Dei ted:Yes NO
-, MCM '
OWNER:Name(Fee Simple Titleholder): -e /-/W � Phone#:
Address: ///I l/I e7201-Z14,0 AIR _
City:e_1a}Zd�L 1weAg5 State: �L-- Zip:
Te aaViessee Name: � Phone#: �U� aG j
Email:
CONTRACTOR:Company Name: A 9, Phone#:
Address:
City: State`' Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
Value of Work for this Permit:$ `r® Square/Linear Footage of Work:
Description of 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,PLUMBING,SIGNS,WELLS,POOLS,FURNACES,BOILERS,
HEATERS,TANKS,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$2500,the applicant must promise in good faith that a
copy of the notice of commencement and construction lien low brochure will be delivered to the person whose property is subject to attachment Also,a certified
copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven(7)days after the building permit is issued.
in the absence of such posted notice,the inspection will not be approved and an inspection fee will be charged.
Permit Fee$ CCF Fee$ Notary$
Technology Fee$ Training/Education 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
Attach color sample with name and number
Fascia: 1 2 3 4
Drip edge: 1 2 3 4
1.
Soffit: 1 2 3 4
Flower Bins: 1 2 3 4
Shutters: 1 2 3 X 4
Awnings: 1 2 3 4
2.
Chimney: 1 2 3 v 4
X
Doors&Jambs: 1 2 3 4
Garage Doors: 1 2 3 4
Railings: 1 2 3 4
3.
Fences: 1 2 3 4
All Brick: 1 2 3 4
Stucco Bands: 1 2 3 4
Other Stucco
Feature: 1 2 3 4 4•
Accessory Bldg: 1 2 3 4
OWNER'S AFFI IT: certify that foregoing information is accurate and that all rk will be a in compliance with all
applicable law regulat' nstru o 7eming.
Signature Signature
O NER or AGENT � CONTRACTOR
The foregoing instrument was acknowledged before rn thl�sa regoing instrument was acknowledged before me this
day of -_� ,20 1%,� by day of C,�<i1 .20 _l. .by
who is personally known too-aJ�S�CafLa,who is personally known to
me or who has produced L-- ZQ as me or who has produced- as
im
identification and who did take an oath� �N 1S �ii,,//� identification and who did take an oath.
NOTARY PUBLIC: �'�'�,'�� NOTARY PUBLIC:
Sign: �.' Sign:
Print: '�i�T c o`er\ Print.
Seal: ���lllll��" Seal: ~rte Notary Public State of Florida
r� Joanna M Feliciano
g�t My Commission FF 082753
OF Expires 01/1212018
APPROVED BY: 7 I q Code Official
Historic Preservation Board