Burglar Alarm•
Date Job Address / c / E 9/ Zia-. Tax Folio /( 3240 401 'DoZ / '��
Legal Description
Owner / Lessee / T enant ^y� (�
Owner' s Address ! / A0/ i 4' / / L,./ • Pl'Z`
Contracting Co. .v Address ✓ / / .33e69
Qualifier - /l�Lt Phone -
State '= Municipa? t. Competency ?fr Ins.Co. 6[i(.G.
Architect /Engineer Address
Bonding Company Address
Mortgagor
Permit Type(circle one): BUILDIN !M; •- LUMBING MECHANICAL ROOFING PAVING FENCE SIGH
fAtt,
ai
- /9- ��.eeo --- Square Ft. Estimated Cost(value) /
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DC
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEN_
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOU:
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, an
on the attached addendum (if applicable). I certify that all work will be performed to meet th
standards of all laws regulating construction in this jurisdiction. I understand that separat
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work wil
be done in compliance with all applicable laws regulating construction and zoning. Furthermore,
authorize the above -named contractor to do the work stated.
WORK DESCRIPTION
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Signa u
Date: Q / -0?'•')
•
Condo President
Notary as to • er and /or Condo President
My COmml s s 1 c !T a s OFFICIAL NOTARY BEAL
<i SARINA M HIRSCH
'' i,_S, * COPAMISSiON NUMBER
, ql ( * 00343646 *
1.'• MY 40MMIBBION EXP
APPROVED:
Zoning
__Mechanical
, %P aY p G q OFFICIAL NOTARY SEAL
i' `1 )rc t• CiiiMMISSIOR NUMB&
* * * * * ..
a
q
CC348646
Q? MY COMMISSION EXP (19
C.C.F. l ' - NOTARY OF Pk. MTI TAIL ,
Fire Other
Building Electrical 9//!(129
Plumbing
Master Permit # 4&24.
Address
Signature of Contractor or Owner- Builder
Date:
otary as to Contractor or Owner- Builder
My Commissi Expires:
Engineering
**
CERTIFICATE OF RE -OCCUPANCY
On benaif of Miami . Shores Village, Florida, the undersigned certifies that the
property described in the above application has been insp t. d fcr purposes of re-
occupancy pursuant to Ser 901 and 902 of the Miami Shares Land Development and
Zoning Code and that such property may be re- ccspieci by the above acpficant for single-
family residential purposes.
Page 2 of 2
MIAMI SHORES VILLAGE, FLORIDA
Date: ciCerfifi cn: 1! 0/7
THIS CERTIFICATE VERIFIES THAT THE REFERENCED
PROPERTY `( i-AS BEN INSPECTED BY MIAMI SHORES
VILLAGE AND HAS B DETE ERMINED TO PRESENTLY
COMPLY WITH THE SCu ULE OF REGULATIONS OF
THE MIAMI SHORES LAND AND DEVELOPMOI T CODE
PERTAINING SOLELY TO THE RECIU1R8VIENT THAT EACH
ONE- FAMILY DWELLING IS USED AND INTENDED TO BE
USED FOR A ONE- FAMILY DWELLING PURPOSE ONLY;
HOWEVER, THIS CERTIFICATE DOES NOT CONSTITUTE
ANY RE OR WARRANTY AS TO THE
CONDITION OF THE DWaLING OR OTHER STRUCTURES
RUCTURES
ON THE PRIISES DESCRIBED HEREIN OR ANY
ASPECT OF SUCH CONDITION, AND IN TER`STEED
PERSONS ARE ADVISED AND ENCOURAGED TO MAKE
"THEIR OWN INSPECTION OF THE PREMISES IN ORDER
TO DETERMINE THE CCNDfi ION THEREOF.
w��..
family residenc2 known as 12 b ( A) . F- , 9 - , Miami Shores. Fcrida.
alkla Lot zj Block 1 , Plat "1 - 1 ( . as a single - family residence.
I hereby certity that l understnd that the zoning of the property is for single - family
residential use and that it is unlawful for more than one family to reside therein_ I also
understand that any Certificate of Re- Oc~:pancy that may be issued by Miami Snores
Village, Florida, ca men only that the referen property is being used for single - family
purposes and that such Certmcte does not constitute any representation, warranty or
c rtficaticn as to the condition of the dwelling or other st ores on such property.
Cate:
Application Received:
Application Fee ($5O) P
Inspection Made:
APPLICATION FOR
CERTIFCATE OF RE- OCCUPANCY
Inspecn: Passed (tn 1 17 .
Failed ( ) because:
hereby apply for a csrtitica to re-:1=4y ate sincie-
Pace 4 r'f 2.
/14 Add
For purposes of Inducting the inspec:ion required by Section 902 of the Miami
Shores Lard Cevelcpment and Zoning Ccce, please contact the fiicwirg perscn(s):
Name: Lie 1,e,4G( Reiaticnsnin:
' gene Nc.: '75y . 4o lo. 0,5 Address:
ii"`O
f
Check Nc.