PAINT PERMITaUILDING
--=LECTRICAL
PLUMBING
Owner o
Buildin
Contractoroe,
or Builder t d' 1'4""ILAWF
PERMIT NC 4313
Work to be performed under this Pe
Architect
v
Legal Lot BL
Description
Ado
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CONTRACTOR OR 1U1LDI
MIAMI SHORES VILLAGE, FLORIDA
DA
Subdi-
vision
nesPaercii
Contractor's
License No.
of
Building *,a9 ,,, I. 6 ( ii ,oi: Value of A or• Project
Address of n , pmennitt.
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or
cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be
drawings, statements or specifications that may have been submitted to and approved by the munic
.7 ; any thne if the work is not done in compliance with such ordinances or if the plans are changed au , Wn,
--- ligrapted is the understanding that the contractor or builder named above assumes the respvnsib4lity . it thorough
to the work covered hereby whether shown on the plans or dra or in er tr,
.P..1 done by his agents, servants or employees;
Signed' By
..-
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with
thereto and in strict conformity with the tsor specifications sulunlited to the proper
Le l a ting this permit I assume responsibility for done by Nottnig,my agent, servant or
APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY) , Job Address 59g I/ Tax Folio // L < / /9 (Ai( `
Legal Description Ai- t"" �(Q'� Master Permit # ,�lf
,
1 0't �
4 14ner / Lessee / Tenant °, L' `i 0 c
Owner's Address ✓7I' ) -, / ".
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
phone
//5`
Contracting Co. Address
Qualifier /1/4/, e., SS# - - phone
State# Competency# Ins.Co.
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION
Square Ft. Estimated Cost % l0 /2C�
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. 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.
natur of O /or Condo President Signature of Contractor or Owner - Builder
te: Date:
43.00
carer n
�OKIUA
No ary s to Owner anY �rnP IL 16 , 19fl; Notary as to Contractor or Owner - Builder
My Commission Expires: My Commission Expires:
* BONDED RU STEM814-ADAMS & S1 Ei
PERMIT FEE: APPROVED: Fire
Zoning
Mechanical
Building
Plumbing
Other
Electrical
Engineering
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
State work to be done and purpose of building (by floors)
STATE OF FLORIDA,
COUNTY OF DADE. Jas •
Disapproved Date
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approyal 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......... -- E!.?�, ci' e e > No 3 0 Street. /.r.0 " - '+'","
Date = r'• ,l
31c. 6 )-7-
,19
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ / V ® ' Q 6 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)
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 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.
Notary Public, State of Florida
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.