RC-15-144 (4) Miami Shores Village
Building Department AUG I 1 2015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
BUILDING Permit No. 10 —202
PERMIT APPLICATION Master Permit No. fz,-, I �t
FBC 20
Permit Type:PAINT ��®°��� 3
OWNER:Name(Fee Simple Titleholder): / OM L (1,��� N�1)ll Phone#: r�v o /
Address: ) ® (9 �+ t1� 6
City: State: r Zip: ®
Tenant(Lessee Name: Phone#:
Email: R J �, ISG /�•� Wl, l.`s�7'� ► �r�atl '�EOW ' /�
JOB ADDRESS: 4 �' yy
City: Miami Shores County: Miami Dade Zip: — 3 y
Folio/Parcel#:
Is the Building Historically Designated: Yes rN Flood Zone:
IC-ONTRACTO :Company Name:gf/e-110,01 L"I" a' `�®d 0'r " Phone#:
Address:
City: _ Stat Zip: zlt
Qualifier Name: �° �� (' Phone#: r� S'�j
State Certification or Registration#: f Certificate of Competency#: /
Contact Phone#: ail Address:
Value of Work for this ermit:$ Squ e/Line r F ge of Work: 4 at
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 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$2500,the applicant must promise in good faith that a copy of
the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the
recorded notice of commencement must be posted at the job site for the first inspection which occurs seven(7)days after the building permit is issued. In the absence of
such posted notice,the inspection will not be approved and an inspection fee will be charged.
Permit Fee$ CCF$ Notary$ Training/Education Fee$
Technology Fee$ Double Fee$ TOTAL FEE NOW DUE$G :3
PAINT COLOR APPROVAL AND AGREEMENT
All elements on the site must be listed and indicate the color to be painted
DIRECTIONS: Please circle corresponding number to appropriate color sample.
Walls: C 2 3 4
Fascia: 1 (Q 3 4
C
Drip edge: 1 2 3 4 q
1. D
Soffit: 1 2 3 4
M
Roof: 1 2 3 4 g
Flower Bins: 1 2 3 4 rri
Shutters: 1 2 3 4
2.
Awnings: 1 2 3 4
Chimney: 1 2 3 4
Doors&Jambs:1 2 3 4
Garage Doors: 1 2 3 4
Railings: 1 2 3 4
Fences: 1 2 3 4
All Brick: 1 2 3 4
Stucco Bands: 1 2 3 4
4.
Other Stucco
Feature: 1 2 3 4
Accessory Bldg: 1 2 3 4
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and t all rk will be don n compliance with all
applicable laws regulating construction and zoning.
Signature: �h- ,� L/ Signature:
Owner or Agent Contractor
The foregoing instrument was acknowrledged before me this Th of instrument was acknowledged before me this
day of 20��by eub)d is m20 day of ,20 byjo.! a q �
who is perso�nall_v +o me or who has produced who is pers nally known to me or who has produced
As identificatioRApd who did take an oath. as identification and who did take an oath.
,��y►r •, Caridad Diaz NOTARY PUBLIC:
NOTA PUBLIC: =:°:..... :Commission#FF 160477
`=Ecpires: SEP 16,2018
• �, 811NDED THRU
IST FLORIDA NOTARY,LLC
Sign. Sign:
Print: �� �� Print:
8
My Commission Expires: G� �(Q/!� My Commis$i 1FF�59b�
oa 2011
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APPROVED BY: Code Official
Preservation Board