855 NE 91 TerrAPPROVED:
Date
Legal Description L.o-ts
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address gs� e� , 9l s¢- Tax Folio // sa e - ,6
/ Lessee / Tenant /...)/056/40t4 / �.�i� u
�.o g,Jl Master Permit # 3 ' Ste$
Owner's Address KZ c...7 A f /-, 1l lfia? . ( Phone 7 1/-- ' i'.
Contracting Co.X Address
Qualifier SS# - - P
State 0 Municipal 0 Competency 0
Architect /Engineer Address
Bonding Company Address
Mortgagor
Permit Type(circle one
WORK DESCRIPTION 71E7 P c..?' , 'A /,t e „ 1,4'c /564'e 1,, A) IW /4V7 0.X // ,2 4g4, L
C✓ /7 + yd.be7 4A 7;,< a lee -'�0 7 ~7 /✓ouc:,e si tPZfL iv -ro G'su e c G' ,[,
Squatme Ft. AN.x. /- Fig' `' /l ,47.es
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.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will
be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I
authorize the above -named contractor
Signature of own r and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
i is 1 .a ? 4 A)/ Q1 4
to do the work stated.
** * * jm•0O * * *
FEES: PERMIT -jV.5 RADON
Fire
Zoning B
Mechanical Plumbin
or
Address
ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING
Estimated Cost(value) s( 4.Sb.>012 — -. 5 '
i nature of
Date:
Notary as to Con
My Commission Ex
C.C.F. Q - NOTARY S_
(Apricot Tone )
tor or Owner- Builder
TOTAL DUE
7
ID el
SIGN
6 11V1
‘il., BARBARA ANN FUGAZZi
* COMMISSION NUM;:I £n
COM C360191
QUO R M SIOU
E7
Other
Electrical
Engineering
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581 N. E. 51$T ST.
MIAMI SORES.
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581 N. E. 51$T ST.
MIAMI SORES.
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State work to be done and purpose of building (by floors)
Remarks
Chairman
Member
Sfember
MIAMI SHORES VILLAGE
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 budding during progress of the work.
Date..._...........1✓_ _.. 'J.. ._._ -... . ,19..
, f) %.., '
Owner's Name and Address . ° �` '� .... .._ ■as . ... l S, ._. No * _.. Street �.:L?..i.: ..`
._.. ... I ......
Registered Architect and /or Engineer
Name and address of licensed contactor tC fl l _ Pi"'' i--./ .i .4,.,,.
Location and legal description of lot to be built on:
Lot.eg,J lei 9 +'. :r lock Subdivision cis (. t • .,€....Z_' ..._._... di !° ....
(9.S'
Street and Number where work is to be done . .S \ -JS- t ...k Ir e--,=r
PLANNING
Member
Member
Member
,......,-- ,.x..,,.•..5,, ... ,1
DATE
A C .,
MY
yy 44,1
and for no other purpose.
New Building Remodeling Addition Repair; No. of Stories
To be constructed of Kind of foundation Roofvng
a i
Estimated Total cost of improvements $ Wa Amount of Permit $
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 labor under the Florida Workmen's Compensation Act, being Section 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 arc required by the Act. The undersigned agrees to employ only such bcontractors, on ork� performed under this
pennit, as are licensed by Miami Shores Village.
(Signed) a ,. _ � 1 A ,' � _, f •
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- _
pealed
to me well known,
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 himis e true.
Permit _ Date � °� Read, Swo to and Subscribed before me.
Disapproved ¢ . Date - .. _
� otary Public, State of Florida
Building Inspector My Comission Expires
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 fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
• 7':