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PAINT PERMITPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 10 5 9, Job Address Lao A/E ql Sh'cc /- Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant x IV] I a AGI 4o e IS / t I I sso- Lit 41)-S Owner's Address --(y4,1,09 a- Sigma ? - iv" / • b Presi My!CommS•�, , - y CZNI't iON FEES: PERMIT l) RADON a _ ent Date Master Permit # 02 g fD e / Phone 3051164 - ) 6 V Address SS# / - ��- �� e4,7,2/ Competency # Address Address Ins. Co. ° NOTARY BOND A Signa ; e of Contractor or Owner - Builder Date © AY" s / otary as to C. tract. orr �wn�er- Builder My Commission Exp : _ Date �� 2 TOTAL DUE •--- 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 building 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. f�ry Owner's Name and Address . r 1 Registered Architect and/or Engineer Name and address of licensed contractor Location and legal description of tot to be built on: /� n Lot / / Subdivision / ‘5, // d ` c Street and Number where work is to be done 4240 J) e--/ y §tate work to be done and purpose of building (by floors). state exterior colors (submit samples) Afr3/ /N MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT BASE 2 (C) ST -34 BASE 1 (B) ST -35 APPLICATION FOR BUILDING PERMIT itlaVEX and for no other purpose. Remodeling Addition Repairs No. of Stories Kind of foundation Roof Covering rvements S 3C' Amount of Permit S - -� Plan Cubage ling Size of Building Lot to by each floor and specifications for said building. All notices with reference to the building and its construction may be sent to this building permit does hereby certify that he understands and accepts his obligatons as an employer of Labor under the Florida Workmen's )n 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar ; 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 blic notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed sed by Miami Shores Village. . (Signed) authority, a notary public. duly authorized to administer oaths and take acknowledgments, personally appeared to me well known. y sworn, upon oath deposes and says that he is the Lion, that he has carefully read the foregoing application, and that he did sign the same. and that all facts therein by him stated are true. Building Inspector Date Read, Sworn to and Subscribed before me. Date O /7` 19 e No. /4" Street /t/ 9/., —r Notary Public, State of Florida My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved late Disapproved Date NOTE: A charge of 525.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship.