1177 NE 91 Terr (9)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
D a t e 1!' 7 4-- J ob Address 1/77 4" 9/ // / . Tax Folio
Legal Description 1/77 Ale e 9/ 7- FA
(/Lessee / Tenant / y!Q r `t Z. P '4
Owner's Address ` l ' e e_
Contracting Co.
Qualifier
State #
Architect/Engineer
Bonding Company
Mortgagor
Square Ft.
OWNER'S AFFIDAVIT: I
Date
My Commission Expires:
FEES: PERMIT 4 RADON
��- 9 ?
C.C.F.
Historically Designated: Yes
SS#
Municipal # Competency #
Address
Address
Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION ins-A& eg.iiet.e.z/Aa
&,bel - 6/ / 6/-ertaiL—E,tizt
Address
Master Permit #
Phone (
No
387 i y
0_6) ?57- 3,27 r'
Phone
Estimated Cost (value) 40-0
Ins. Co.
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regula • ' $ : u 4 oning. Furthermore, I authorize the above -named contractor to do the work stated.
Signature of Contractor or Owner- Builder Date
otary as to Owner and/or Condo President Date Notary as to Contractor or Owner - Builder Date
My Commission Expires:
NOTARY TOTAL DUE d
APPROVED:
Zoning Building / ` 1 ) Electrical
Mechanical Plumbing Engineering
BUILDING INSPECTION DEPARTMENT.
APPLICATION FOR BUILDING PERMIT
Application is hereby wade for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
peared
Permit No.. / rS
MIAMI SHORES VILLAGE
Owners Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor
Date
Disapproved {` Date
(Signed)C l
Building Inspector
!l"� 0 . z`✓ C /'
Location and legal description of lot to be built ori:
Lot Block Subdiv''sion
Street and Number where work is to be done /1 ?2 y E Cj ._. ``'`�"`� tit Cie- rat i
State work to be done and purpose of b ulding (by floors) 'f t �` �' `'° `r °�
Date..._.....IS L � , 19.._.-
_ No Street._..
New Building Remodeling Addition Repairs
To be constructed of Kind of foundation
Estimated Total cost of improvements $ ( 9-. ) S D amount of Permit $.
Zone cubage required .Plan Cubage
Distance to next nearest building Size of Building Lot
and for no other pu
i1 No. of Stories /
Roof Covering
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the "Florida Workmen's Compensation Act, being S' ction 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to, be performed under this
pennit, as are licensed by Miami Shores Village. - -
Remarks (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. ss
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
and who, being by me first duly sworn, upon oath deposes and says that he is the.
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
to me well known,
PLA INC BOARD DATE
Chairman Member
Member Member
Member ..... Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re-inspection fee of $1.00 will be charged when such re- inspection is rnade necessary by improper notice for inspection or faulty
materials and /or workmanship.