PAINT PERMITPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date .5 Job Address 553 /1M 9/ Tax Folio
�,,� s� y,o
Legal Description Historically Designated: (Yes ath c7A No
/Lessee / Tenant r/ 0 p_e/Letc2. Master Permit # ` � ` ;5 5—A? Owner's Address AM 97 JI' . Phone 75'7 i �� �' ��
Contracting Co. D�itit Address
Qualifier SS#
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 DESCRIP'T'ION ea,(4/ /I6Zf.S.Q.. l.{>l /ld D c d // vi
Phone
Square Ft. Estimated Cost (value) 50 424) 424)
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 '
certify that
permits are r i ,-
OWNER'S
laws regulz
Signature of oa Date
Notary as to 0'
My Commissic
FEES: PERMIT / 7, 4 D RADON C.C.F.
APPROVED:
Zoning
Mechanical
- -L- -. to
obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
- -► meet the standards of all laws regulating construction in this jurisdiction. I understand that separate
.UMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
the foregoing information is accurate and that all work will be done in compliance with all applicable
ermore, I authorize the above -named contractor to ;i the work stated.
Date
Plumbing
Building 11.
Signature o ontractor or
0
Electrical
er- Builder Date
4a)r)'L
Notary as to Contractor or Owner- Builder _ - Date
My Commission Expires:
e-7/7
NOTARY# BOND
TOTAL DUE 4- 6 --- -k.)
Engineering
•
Permit No.
Disapproved
'Signed)
w
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.
^yam Date 19 P(') Owner's Name and Address. )4' . m6 S. `� `f' - 4- F-5> -353 1.j 9 ' STN. Street
Registered Architect and/or Engineer
me and address of licensed contractor r wt-'
Location and � legal / description of lot to be built on: Q
Lot b /i� 4 / Block l/ Y Subdivision 7 .9 kei1 / /J � �
� 7 ji z G�� / [' - '0
C4treet and Number where work is to be done 3s 3 p+/ • -(5- - / ! `fir g #2''
1.....--grate work to be done and purpose of building (by floors), state exterior colors (submit samples)
and for no other purpose.
New Building Remodeling Addition Repairs No of Stories
To be constructed of Kind of foundation of Covering
l timated Total cost of improvements 5 .-2, a Amount of Permit $ t 5
Zone cubage required Plan Cubage
Distance to next nearest building Size of Building Lt
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 buildi, d=rnr be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons 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)
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
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.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
4
Data /`//f /// Read. Sworn to and Subscribed before me.
Date
H1/1 git iJeif
Notary Public. State of Florida
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Tate 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 525.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship.