PAINTING PERMITPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date T,b Address /()77 ?/ Tax Folio iigoW` A3e
Legal Description / 5-4* I .Z LJ aS•g
Owner / Lessee / Tenant 'tu 1 e Master Permit #./ %
V 5 Y�. .1
Owner's Address / / : 7 r Phone
Contracting Co. / 0iZ�lt� Address
Qualifier SS# -
APPROVED:
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 SIG 1
WORK DESCRIPTION
Square Ft. Estimated Cost(value) e ,
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
Arkg. 4041
t,470/,kg
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
PHINE CHUP K
r- Builder
ary as to Co
y Commission E
** * * * * * * * * * * * * * * * **
FEES: PERMIT ,37,6 RADON C.C.F. / 452' NOTARY ,1 TOTAL DUE "
Fire Other
Electrical
Zonin_ Buildin
Mechanical Plumbing Engineering
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date I - .9 c Job Address l o ? I t .1.^ Alf ` T5? . Tax Folio 1 1 32 d 6 d l 3 3300
Legal Description Historically Designated: Yes No v/
Owner/Lessee / Tenant T h h
of
Signature of owner and/or Condo President Date
My Commission Expires:
khh,S: PERMIT 1 1 0 RADON
C DrIr yr - elr
Master Permit #
Square Ft. Estimated Cost (value) 0 srQQ.
Owner's Address in'? N_ E'. q( r= 54-. rn o.r►, S1,o,sr r{ 33/3 ? Phone C309 1s -1 yg
Contracting Co. n( //.}. OW ME X- Address fvVA
Qualifier WA' SS# K/ Phone
State # IVA- Municipal # h01._ Competency # J/ Ins. Co. M /A.
Architect/Engineer f /). Address WA-
Bonding Company �//i- Address N l4
Mortgagor ` Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION O w n - ' -Lo p 7 to + bWn hdi,s'e SGML C-, (or (,NA de) IN arl
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.
Sign e of Contractor or Owner er Date
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner- Builder Date
My Commission Expires:
m Sr)
C.C.F. NOTARY T OTAL DUE � ,S'.
APPROVED:
Zoning Building Electrical
Mechanical Plumbing Engineering
Application is hereby made 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.
S AC.1<._ Date __.___ , Owner's Name and Address____ t 3 _____ _ No I.C1r Street _ � �x . •'
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block Subdivision_
Street and Number where work is to be done ____ C
State work to be done and purpose of building (by floors).
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
Permit No
Disapproved
( Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date
Building Inspector
New Building Remodeling Addition Repairs
To be constructed of Kind of foundation__
and for no other purpose.
No. of Stories
Roof Covering
Estimated Total cost of improvements $
______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 are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed) t
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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 1 Farefull read the foregoing application, and that he did sign the same, and that all facts
therein by hi sta are e.
Date_ __ _? 1 Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOA 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 made necessary by improper notice for inspection or faulty
materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description,
Address of
Building
Lot
Ottiest II
This permit is granted Fo the contractor or bil lder named
herefor in strict compliance with all ordinances pertaining there
drawings, statements or specifications that may have been snbmitt
time if the work is not done in compliance with such ordinances or
granted is the understanding that the contractor or builder named
pertaining to the work covered hereby whether shown on
done by his agents, servants or employees.
In consideration of the issuanc
pertaining thereto and in strict conforms
In accepting this permit I assume responsibi
f �
CON RACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
❑ PERMIT 1■° 12247
Work to be performed under this Permit
B L
ove
and
l4
L &LNG
eipateWcf
Subdi-
vision
Value of
Project $
DATF
cf:tir
Contractor's
License No
Amt. of
Pe
s /CO
195L
construct the building or to install the equipment or device described in the app ion
with the understanding that the work will be performed in compliance with any plans,
nd app raved by the proper municipal authorities. This Permit may be revoked at any
plans •. changed without authorization. A further condition upon which this permit is
assum= the responsibility for a thorough knowledge of the ordinances and regulations
wings r in the statements or specifications and at he assumes responsibility for work
to me of this permit I agree to p
ith the plans, drawings, state
all work done by
orm the work covered hereu n complia -e with all ortliiiances and regulations
ents or specifications submitted to the prope authorities of Miami Shores Village.
er, myself, my agent, servant or employee.
BY AUTHORITY