878 NE 91 Terr (5)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date / – x ( 6 1 Job Address 8 7 Air Cf 1 7Ptr Tax Folio
Legal Description Historically Designated: Yes No
O w n e r / L e s s e e / Tenant C A t" I o 01 {-{ q n d Master Permit # 6 (0
Owner's Address Phone 3 O S— 7 ) - 3 ;)S 7
Contractin Co. O \kw F P Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION Pct 1/11 p ry)C w Iil t r e . t lx-ki
PG l it 1 1. 1 culh' 7 e
Square Ft. Estimated Cost (value) -1
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 to do the work stated.
Signature of owner and/or Condo President Date
FEES: PERMIT 3 6-2- — RADON
APPROVED:
Zoning
Mechanical
- I-' )G .'�
Notary as to Owner and/or Condo President Date Notary as to Conor or Owner - Builder
My Commission Expires: My Commis
Signatur of ontractor or Owner - Builder Date
C.C.F. NOTARY 5 .
OFRCIAL NOTARY SEAL
0 11 h2 PU d G 8 MARGARITA MON11EL
•A j COMMISSION NUMBER
qr CC797277
0 MY DEC. MISSION EXPIRES
OF
Date
BOND
TOTAL DUE S S. 6v
Building cj/Irr Electrical
Plumbing Structural Engineer
State work to be done and purpose of building (by floors)
STATE OF FLOI;IDA,
COUNTY OF DADE. ss.
Disapproved
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of thc detailed statement ur we 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 \'ill,ige, Florida. and all provisions of the Laws of thc State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of thc building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
pl,uns and specifications must be kept at building during progress of the work.
Owner's Name and Address .. . /.,l..il f..! 2 Y /V. cz 7/ i e - No Street
R egistered Architect and /or Engineer ,,,•••.,••,•,,.,-- •,- .••••,,, r -.
Name and address of licensed contractor V C •" G 0 P, ��$...._ / /C; / 4 ' MIL) .Q t' A_ �E
Location and legal description of lot to be build: on: �'
Lot . Block Subdivision —...._ _
S and Number where work is to be done F - c
and for no other purpose.
Ncw Building Remodeling Addition Repairs No. of Stories / _
To be constructed of Kind of foundation Roof Covering l i /�
Estirnatcd Total cost of improvements $ 7 ° ':- -Cs i) Amount of Permit 5,.... .00
Zone cubage required .Plan Cuhage
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. ... .. .l 4... ..... c_.. .,E?..0 /._ / /t/ fl
Date.
Date /2_ , 19.
The un,ler,icocd'applicsnt for this building perinit does hereby roily that he understands and accepts his obligation% as an employer
of labor under the Honda Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Sipplenient,
and has complied SA it the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hint
in d:e 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 subcontractors, on work to be performed under this
licensed by Shores
pennit, as are icense y Miami ores i II
age.
Remarks (Signed) . .. 1
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 tl :c above described construction, that he has carefully read the foregoing application, and that he did sign the same, sad that all facts
therein by him stated are true. No ..V..1 re Date... )Z91/1 Read, Sworn to and Subscribed before me.
to me well known,
Notary Public, State of Florida
uilding Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Mcmbcr
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 fmnn
the I'Luuiin Board.
A rc- ,n'pr•ttion 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.