ROOFINGMIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date
Type Insp'n raj
Permit No. f_-.) P LL 1 — Y
Dcr,5rk tct x_(cJ
Name
Address
Company
tC r) , 2�
Phone #
Inspection Date
Correction
Re- Insp'n Fee
6 10 91 e s-)--
6) 6,
\p/
t
Miami Shores Village
BUILDING°"
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
(Continued on opposite side)
Building Department
Submittal Fee $ Permit Fee $ .O CJ . 0 0
Notary $5, DO Training/Education Fee $ o� O
Scanning $ Radon $
Code Enforcement $
Electrical Plumbing Mechanical
Owner's Name (FeSimple Titlehol t$4Jd 4- ; 'Phone # 7 'q l�Z
Owner's Address 1- 0 Y l (
City l.,,/ 7 t S &► 4State Zip +✓ 33 33
Tenant/Lessee Name Phone #
Job Address (where the work is being done)L_- 1 O E
City Miami Shores Village County Miami -Dade Zip �✓ S 3 6
Is Building Historically Designated YES NO ' \
Contractor's Company Name Phone #
Contractor's Address
City State Zip
Qualifier
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permi Ze)
Type of Work: ❑Addition ❑Alteration ['New X Repair/Replace ❑ Demolition
Describe Work:
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Zoning
Structural Plan Review. $
Total Fee Now Due $ 3 0
Permit N
Master Permit No.
Square Footage Of Work:
Roofing
CCF $ b CO /CC
Technology Fee $ / / SO
Bond $
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a pennit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me
200_, 1,3
APPLICATION APPROVED BY:
Chc 12/15/03
i
Signature
Contractor
The foregoing instrument was acknowledged before me this
, day of ,20
who is personally known to me or who has produced FLD L-. who is personally known to me or who has produced
identification and who did take an oath.
State Certificate or Registration No. Certificate of Competency No.
as identification and who did take an oath.
NOT LIC: , NOTARY PUBLIC:
Sign: i / � ►: .� Sign:
Prin ' 3 Print:
My Commission Expiiti^` "' A My Commission Expires:
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
(Certificate of Competency Holder)
************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ,* *************** * * * * * * * * * * ** * * * * * * * * * * * * * * * * * **
MAR 2 4 2004
Plans Examiner
Engineer
,sa' 3/47Y Zoning
City Miami Shores Village
•
Walls
Shutters
Awnings
Chimney
Doors and door jams
Signature Z
• Miami Shores Village
Paint Color Approval and Agreement
ri") 27
Date 2a,
Owner's Name
Owner's Address 1 Y 1
Ci ty , State L
Job Address (where the work is being done) C o AI y / �,�
County Miami -Dade Zip ,.."3e,
Is Building Historically Designated YES NO K.
Contractor's Company Name (if applicable) 4— 1c v y._6.5.5„c-
Phone # ' ,Zo .;-��
# # # ## #*####### # # # # * # # # * # # # # # # # # # # # # # # # # # * # # ##
All elements on the site must be listed and indicate the color to be painted
Fascia
Drip Cap /dri Edge A)
Soffit 6
Roof t �— �� �9 ' L -
Flower bins
lv�
Garage doors .
Railings o
Fences \1
Decorative metal
All brick (simulated o egular)
Stucco banding
Any other stucco features
Accessory Buildings
Other
**************#***********#*******#***#***#****#***#****#*#****#**#***#****** * * * * * * * * * * * * * * * # * * * * * * * * * * * * * **
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.
APPLICATION APPROVED BY:
GV�
Owner or Agent
P& Z Official
Phone # � — t4
Zip ( �'
Attach Color Samples
With Numbers
Date22 A )' \. ( 1 D'
Date
n
chc 6/18/03
Building Permit
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: BP2004 -392
Printed: 3/26/2004
Applicant: ANNE SUNSHINE
Owner: SUNSHINE ANNE
JOB ADDRESS: 290 NE 91 ST
Contractor
Local Phone:
Parcel # 1132060190400
Signed: (INSPECTOR)
Contractor's Address:
Legal Description: EL PORTAL PB 9 -101 LOT 3-4
Page 1 of 1
BLK 3 LOT SIZE 100.000 X 135 OR
Fees: Description Amount
FEE2004 -3240 Building Painting Fee $60.00
FEE2004 -3241 CCF $0.60
FEE2004 -3242 Notary Fee $5.00
FEE2004 -3243 Training and Education Fee $0.20
FEE2004 -3244 Technology Fee $1.50
Total Fees: $67.30
Total Fees: $67.30
Total Receipts: $67.30
Permit Status: APPROVED Permit Expiration: 9/18/2004 Construction Value: $450.00
Work: PAINT ROOF WHITE TO WHITE
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict
conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
Legal Description
Owner / Lessee
Owner's Address
Contracting Co.
Qualifier I f �la
State #
Square Ft.
C
APPROVED:
/
/(fe7.
Zoning
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address 4 /V / C � >
Tenant //it)tii%r/
/V? /
.r, ( 4 }1
A lK<J SS#
Architect /Engineer �/ /'
Bonding Company A
,3e
S ignature of owner and /or Condo President
Date: �
t �
ary asp --t Owner and /or Condo President
y Commission Expires:
SP R Y PU KIMBERLY S. 8URU
i , COMMISSION * CC 463156
EXPIRES Y 11, 1999
* ED THPU *
** * i 1
Of AT C BONDING CO., INr .
FEES: PERMIT //2 RADON
Mechanical
Tax Folio / 6 3. 4 / 6 7 C (166
Address r
Phone
Municipal # Competency # ('� f`,. /'2 /t Ins .Co .
Address
Address
Mortgagor Ai if Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION ��� ( /1'f .� /CG` ✓� /// `J/ e.1, (./. r' /7C
Estimated Cost(value) /,5
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 construe and zoning Furthermore, I
authorize the above -named contractor to do the work stated.
1
gnature of Con racto or Owner- Builder
Date'
Master Permit #
Phone /7`,"
tary as+ -L ontractor or Owner- Builder
y Commission Expires:
ctSky KIMBERLY S. BURNS
= 'ii n COMMISSION #t CC 463156
* * * c3 ' 511 *. EXP IES MAY* i, 1999 * **
yr /Z` � {lA1J Tuol
OF FV ATLANTIC
Fire
Buildin
Plumbing Engineering
Other
Electrical
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
/1
96R053014 1996 FEB 06 13 :32
/
PERMIT NO. TAX FOLIO NO. l 3 : 26) D / 6<
STATE OF FLORIDA:
COUNTY OF DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. Legal description of property and street address: l,LDT 3 . - L /
.2 ?C Ak 9/ „s -T
2. Description of improvement:
4. Contractor's name and address:
6. Lender's name and address:
different date is specified)
a
/( 'V 7 4m/77419
3. Owner(s) name and address: (G/L/)Nfci) . cel/thcf/ /ke,
/ tit, y'l /y7 / fin s / iee,c) -�
Interest in property: n/i Y'J J/&
Name and address of fee simple titleholder: Ali A
5. Surety:(Payment bond required by owner from contractor, if any)
Name and address: /LJ
Amount of bond $
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided
by Section 713.13(1)(a)7., Florida Statutes,
Name and address: /U) r�
8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in
Section 713.13(1)(b), Florida Statutes.
Name and address: a 4
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
Signature of Owner /
Print Owners Name t/ 4l S / ti.�?J`f //)1
Sworn to and subscribed before me this 6 day of Fi
( imp_ r
99e /Wv IQ SY . /4izA - ii <
o ovf. Po KIMBERLY S. BURNS
Notary Public
Print Notary's ' ame
My Commission Expires:
,U/ 4--
NV OF DPLIE .
I� AT : OF I'L!`RIDA9 OOU o 9r o¢ i�t�
fls a d
Iii` -2 I' Y " 1 i i ` d',.../ 0.
m i I.
J '. 1 S -- - - o n - '. _ . D. t /1
0,-1.
CIS ✓Jt
,19 9 -b.
MAY 11, 1999
THI U
ATLANTIC BONDING CO., INC.
,! ;:ounPy Courts
333 i/
Prepared by:Ck1i -00/91
3 79k A/AI / /sj
Address: 064 - 1 , 4 l / /Z( �G /
123.01.52 2/93
uaz
GALE:
S_ 3.t 4 .., '.5.I /.0K 3 • EL_ ' ORTAbL
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date .7 r ?„5
. ) Job Address r- C (', i' Tax Folio
Legal Description
6 Owner ,)/ Lessee / Tenant P 4t ;e . - 4 1 . '
Owner's Address A 9 6 P s ) 2''e1
Contracting Co. ��'
Qualifier SS4t. ( • -'� Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PL ING MECHANICAL ROOFING PAVING FENCE SIGN
° i1�:� C'n ic^,
WORK DESCRIPTION ( = y� Y ?� -�C� Lei
C (E- (
CIE kJ Roop
Signature o owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
** *
* *
FEES: PERMIT 3 ? RADON C.C.P. -- / NOTARY 67
APPROVED:
Fire
Zoning Buildin
Mechanical Plumbing
Master Permit # 73.462.2_
Phone < -,
Address
Square Ft. Estimated Cost(value), e j )
Not
My
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- med contractor to do the work stated
Signature of Contractor or Owner- Builder
Date:
6%- ; -
y, 4W Rt, O eeciaM NoitR > r- Builder
• . !, , . 4
Ert#Pftedi "Wm
tEl
. At L,_ si12$1
* **
TOTAL DUE ' 3,
Other
Electrical
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.
Owner's Name and Address
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date
No - street
Registered Architect and /or Engineer
r�
��
Name and address of licensed contractor - C i _ 0
Location and legal description of lot to be built on:
Lot Block Sub ivision _
Street and Number where work is to be done e r 2 v , 94:11_. -
--
State work to be done and purpose of building (by floors) --" "Z `f P`� �C
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foun r _ , _ 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 su ' ntractors, on work to be perform under this
permit, as are licensed by Miami Shores Village. -
Remarks ( Signed ) k t . STATE OF OF FLORIDA, < r c- f. r ',.__
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
7-
19
— -
....................... - 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 him stated are true.
Permit No Date Read, Sworn to and Subscribed before me.
Disapproved Date
Notary Public, State of Florida
(Signed)
Building Inspector My Commission Expires
PLANNING BOARD 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.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
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.
Date Capri 1 ath„, 71 ,1
Owner's Name and Address... Ii.... '3_, Bloomer No 290 Street ' H
Registered Architect and /or Engineer
Name and address of licensed contractor
Lan oo _nr.. , .7c Tile Co., Inc._. /30. . .. 7nt'; S
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done 290 11;. ?1St St. 4 er Tnor = s 9
'State work to be done and purpose of building (by floors)
tear off e.nd re- , roo "irp residence 35: se. s°Polace
s'�i n 1 e t 7. . Sc::.' ,
,19
20 pualo pravanizc.3 iron eave drip and valleys. and for no other
purpose.
New Building Remodeling Addition Repairs X No. of Stories
To be constructed of Kind of foundation Roof Covering '- 'Y -' - 6 c e'
Estimated Total cost of improvements $ 1735.00 Amount of Permit $ ,„no
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 suc ubcontrac (Si t
(Signed) on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks
_. /_
i :1 A, n tir Vico Pyre jrie ;
STATE OF FLORIDA, J
COUNTY OF DADE. ss.
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 carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No ___� Date d Read, Sworn to and Subscribed before me.
Disapproved j Date.__ .)__ f
(Signed) .... �- L-- ` = ---= � /
Building Inspecto
to me well known,
Notary Public, State of Florida
My Commission Expires
ANNING BOARD 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 Lot
Description
Address of
Building
CI PERMIT N° 3996 Contractor's
License No. 't ; I
Work to be performed under this Permit
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
DATE 4t 4
B1
Subdi-
vision
Value of „.
Project $
,
BY AUTHORITY
I j
Amount of
Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
Signed. INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in complianbe with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper crthhorities of Miami Shores Village. In as
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
AllOT PRINT
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
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 provision:: 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.
Owner's Name and Address LV J c V 4 . H ( No. t1 Street /A ' f {
Registered Architect and/or Engineer f ,�/
Name and address of licensed contractor C ` I M - r 0 , L.7
Location and legal description of lot to be built on:
Lot 3 4- Block Subdivision _ / f - C.- P G t / / L // 7 C-,
Street and Number where work is to be done rdt 5 , 46- ��j Sr
State work to be done and purpose of building Iby floors). state exterior colors (submit samples)_ Pk_65 - f C AN - _
77 / h fl Sig//1 L �('ooF- SE/ &/fri /s 7t vv 1J1�1
t/kot ° V T/ 1125
and fcr no other purprno
New Building Remodeling Addition Repairs No. of Stories _
T be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements S _ 0 - g' Amount of Permit S
Zone cubage required
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all plans and specifications for said building. All notices with reference to the building and its construction may be sent to C I'I'p /I
Plan Cubage
3 G�
Cc Al T ° a � T -& � / ' 6 /0„1. F L,1.4) FL 3 “ t)-
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons as an employer of Labor under tht Florida Workme n'*
Compensation Act, being Section 5966. Compiled General Laws of Florida. Permanent Supplement. and has corn '•d 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 thi t: and will post or cause be posted for inspect:on
on the site of the work such public notice or notices as are required by the Act. The undersigned agre• % • ploy only such su rs. on wo-k to be performed
under this permit, as are licensed by Miami Shores Village. , r _ .��_
Remarks (Signed
Permit No. ,rT '2 Date
Building Inspector
Disapproved
(Signed)
Date
Read. Sworn to nd Subscribed be
Date / ' . 19 TO
Notary Public State o ' lorida
My ommission Expires
STATE OF FLORIDA
COUNTY OF DADE. } ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
/ V I LC- /S to me wellknomn
and who, being by me first duly sworn, upon oath deposes and says that he is the C Q r 1) A C 7 / t
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 Lim stated un true
fti�ji/�RY `i r t},t' Fi_Ih <ii}x
MY COMMI .E,i "ri4 LAP (!1 P.20, Ig9..
em
[3�D Thal GETJ�i�ttw !N,i. t!
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member _
Council Approved Date Disapproved Duu
NOTE: A charge of $25.00 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.