1241 NE 91 Terr (3)State work to be done and purpose of building (by floors)
STATE OF FLORIDA,
COUNTY OF DADE.
Disapproved
(Signed)
ss.
Building Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby tnnde for the approval of the detailed statement or me 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, whcther herein specified or not. A copy of approved
Oak and specifications must bc kept at building during progress of the work. ,M /
Date..._...L 2 / _1.4 - " & _.__.L_._..._._._..._... 19.ES
Ova nes Name and Address .......\ ......k. Q... .._ a a'f .. k....._._ No... s` Y./..,11 Street_... 9/ . f L'-
Registered Architect and /or Engineer t,.,. Wt. ••.t „ *.•..
Name and address of licensed contrlctor...J-- °LL.Q.Ce —f..8. _. ..:.. i t/
�.i.IJ . _... .moo Zi...&...r “..i.2 ) 4:2 ;':"...'. ..
Location and legal description of lot to bc built on:
o� t f r Ly 3�
Lot3 � Block / Subdivision.. _..._ —
6i / 4
Street an t' umbe r when work is to be done , 2.4—‘ ..:. . ..?i..L.. _ s_
ate.
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories _
To be constructed of Kind of foundation ji000vering
Estimate Total cost of improvements $ ' 0 Amount of Permit 5.... 2
Zone cubage required Plan Cubage
Distance .to next nearest building. Size of Building Lot
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 Libor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and his complied %%ith the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in the work to be performed cinder 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 subcoptractors, on work to be performed under this
pennit, as are licensed by Miami Shores Village.
Remarks
(Signed) Q
(� G � 3 �cP
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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 car fully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are / f
Permit No.._. I p ate 1 ! l % Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
to me well known,
PLANNING BOARD DATE
Chairman Member
Member Member
Member .. .. _ .....__....._..._.r...._....... Member —
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application niter approval has hecn obtained from
the 1 I.innir,;.: Board.
A re fee of $1.00 will be charged when such re inspection is made necessary by improper notice for inspection or faulty
materials anti /or workmanship.
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Date 3 e iI Job Address 124 t NE 1 Te& Tax Folio /O J t 91
Legal Description jdifrf / L. t-' s,c f /� l M j Wit. # .:5 s dZ 9
Owner / LON " 42!I .14, in Rj'j
Owner's Address I' 4 t U T FT ? _. PhonelSg .1OS'O
Signature o s .er
Date:
Architect /Engineer
Bonding Company
Mortgagor
Contracting Co.
Qual ifier At ` 1e c s le v Phone �. L
State # CAC' EX? 9Okj nc Ins. Co.
/6s27
Address
Address
Address
Permit Type (circle one » BUILDING ELECTRICAL PL
WORK DESCRIPTION
7l° as
Square Ft. 25000/
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE T
DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YO
INTEND TO OBTAIN FINANCING, CONSULT WITS 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, 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'al1 the foregoing information is accurate and that all won
will be done in compliance with all applicable laws regulating construction and zoning -
Furthermore, I aut •. raze the above -named contractor to do the w• =ted.
Notary as to Owner and /or
Hy Commission Expires:
PERMIT FEE: APPROVED:
Zoning
Mechanical
Pig I S 19 9 1
Condo President
Notary as to Contractor
My Commission Expires:
* * * * * * * * * • *
Fire
B ilding
Address
Estimated Cost4/D/90 %
Signature of Co
Date:
Other
or Owner- Builder
Electrical
bin
(� g Engineering
II) Squares to the Inch
cJ
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20250 NORTHEAST 15th COURT MIAMI, FLORIDA 33179
DADE 652 -6040 BROWARD 764 -0489
PURCHASER
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DADE 852 - 6040 BROWARD 764 -0489
PURCHASER
ADDRESS
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