PAINT PERMITAPPLICATION FOR BUILDING PERMIT
Application is hereby inndc for the approval of the detailed statement ur Inc 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 ..%%.'Y..i.Gt ,...
g
F i >y
Registered Architect t cct an d/ or Engineer .,•..,.,..,G,,,,,,
�
Name and address of licensed contractor .�:�f/Iri—S/ 4
Location and legal description of lot to be built on:
Lot Block Subdi
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
Disapproved .*
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Date... _..__ _ _ ..._._._
.... _ ...... _ �. No........ ...... Streets., . 1�1.L�
vision
and for no other purpose.
New Budding Remodeling Addition Repairs
To be constructed of Kind of foundation Ryo overtng
Estimate Total cost of improvements $
/COO 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 sc ith 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 subcontractors, on work to be performed under this
pcnnit, as are licensed by Miami Shores Village.
Remu ` ks... (Signed) � ��^
peared
Notary Public, State of Florida
Building Inspector My Commission Expires
No. of Stories _
STATE OF FLORIDA,
COUNTY OF DADE. f ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
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 scat d are true.. ' 1 p j�
Permit No.._.. 1 �3 Date `' tq' `r Read, Sworn to and Subscribed before me.
Date
PLANNING BOARD DATE
Chair ;ran Member
Member bfembcr
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 (roan
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.
Date
Date:
Notary as to Owner
My Commission Expir
** *
FEES: PERMIT _I
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
.V4S/Job Address
WORK DESCRIPTION
I • IA��c SEAL
J1P 4 'i BARBARA ANN FUOAZZI
* it * COMMISSION NUMBER
Fire
Legal Description
Owner / Lessee / Tenant (-� ' , e- - k 4 � / 46-1 " -4;"
Owner's Address ='? 5e ) 9/ 1 .;='ei_ + ` Phone '75' t
Contracting Co. 9 i ?p^ Address s,iM // (2/j /, 6
Qualifier SS# , �' Phone 9A •( ,. :/
State # Mt romoetency # Ins .Co .
Architect /Engineer
Bonding Company
Mortgagor A uress
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Square Ft. Estimated Cost(value) / 2,•
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 sta
� /
Cam. Y1,e��� , `' -BZ;� - x - 11 ��T/1l3 '� , !�( =` �- �l
7 =
Signature of owner and /or Condo President nature of Contractor or Owner- Builde
CA 111 5 Q CC360191
�" F" �O MY C MMISSION EXP.
* * O F\. R. 29,t998
RADON C.C.F. [156
Zoning Building
Tax Folio
ate:
Master Permit #
Electrical
4
e. 0) t ,;%%:a ��/! .; ff x /6 / ; ,/ , ?;
Notary as =Builder
P if 2gEICIAL NOTARY SEAL n
My Commiss Q�1 x p . /M BARA ANN FUGAZZI
l 1 * COMMISSION NUMBER
a Q CC360191
(' "* p` M' COMMISSION EX*
O F Ft- MAR. 29 19983
NOTARY y �1 1 t1 TOTAL DUE �j
** r
Other
s•
Plumbing Engineering
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date r l /- 2.2- 9? Job Address ,:57,2 /f`' (` 9'7 ` Tax Folio
Legal Description Historically Designated: Yes , 6.----- er/Lessee / Tenant 75 f : X f e c c 5 Master Permit s -e/y `- 5 -79 (9_.
C _
Owner's A d d r e s s r " � / c , / # Phone 3 y ' / ( - C) - s° ;, "'
Contracting Co. .) Af ; k-- 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
My Commission Expires:
Square Ft. Estimated Cost (value) 3F)0
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 authorize the above -named contractor to do the work stated.
gnature of o ereand/or C President Date
Notary as to Owner and/or Condo President Date
Notary as to Co ctor or Owner - Builder
My Commission Expires:
FEES: PERMIT /5 RADON C.C.F. "(� NOTARY BOND
Date
Date
APPROVED: TOTAL DUE Zv
Zoning Building t( (i7)fl Electrical
Mechanical Plumbing Structural Engineer