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FENCE PERMITAPPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement or me 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..—...---.. Owner's Namc and Addrese .... A � ��'% ..» A — No..: ��� ». »....... StreeL.4 i`l &• Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: Lot Block Street and Number where work is to be done State work to one and purpose of building (by New Building To be constructed of be sent to. peared Disapproved (Signed) NOTE: A charge of $1.00 will be made for the Nanning Board. rc•in (ce of 31.00 will be charged materials anti /or workmanship. av MIAMI SHORES VILLAGE - ---� BUILDING INSPECTION DEPARTMENT Chairman Member M(embcr _.....__....._.... Council Approved Date IPLANNINC BOARD DATE TM VII •• •e.,•ser.t,netawe•vn..veSCHT!se Subdivision 921 . »....... ... »..�....__..._ ._....._._... ......... 2 ... - r te : mono__ ._» f!E �✓0 6/2 /_� �- ..... � c � »..._.___�...._.... ,� p Date.._.. �11 Notary Public, State of Florida Building Inspector My Commission Expires _. »_... »........ for no other purpose. Remodeling Addition Repairs' No. of Stories Kind of foundation Roof Covering Estimated Total cost of improvements $ Amount of Permit $.0 Zone cubage required _Plan Cubage Distance .to next nearest building Size of Building Lot Mfaxirnum live load to be borne by each floor 1 hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may 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 SupIpleutent, 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 arc required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this pennit, as are licensed by Miami Shores Village. Remarks... (Signed) STATE OF FLORIDA, COUNTY OF DADE. j 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 stated are e.. Permit No �� �L d Date � ._ ......._._ Read, Sworn to and Subscribed before me. Member Member Member Disapproved Date J making corrections or changes to this application after approval has been obtained from when such re- inspection is made necessary by improper notice for inspection or faulty PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) D tae -?� 7 - "2 Job Address 7 �/ 7/ S / 1 i2 S �;'� /gu � � � Tax Fol owner / Lessee / Tenant l � P i2 R.) a l ©s -Q- Master Permit # Vtwner's Address Contracting Co. al' E f I e_ Qualifier e / 4 * - -) Phone / _ -d `' s j;\ State # Municipal t Competency 4� / ' 7 ' .Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN `WORK DESCRIPTION / 7 45 O' / Legal Description Square Ft. 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 a thorize the above -named contractor to do the work stated. t y - r„,„ , 1,44 ei 4>-1, c � Sagnatare.of owner and /• Condo President Date: 7 Notary as to 9wnezv fbr Condo President My Co mission E /1res. FEES: PERMIT APPROVED: ,6 S a s: Zj/ "ee /e 4 >' v 6 9/ 7 * Phone 7 r/° .4 2 Address 6 6 9 Estimated Cost(valueT f76; z) * Signature Date: c ary as to tr for or Owner- puiider fy Commass on Expires: E . , * r or On er- Builder * ** RADON C.C.F. ' t(10 NOTARY TOTAL DUE ,C` Fire Other fr1/ Zoning Building 1 Electrical Mechanical Plumbing Engineering e r a.di:? NotC o U nCde rq rouncc Cn(° !'Oi'.(..l:.: utilities, it.Les o . any, not T4)C (: o ownership by V'.sua 1. in('-an V ownership not determined. ned FLOOD . ZONg X Le r " i E'CY Tog Trans-State ._ . . 11 Corporation, P i UV °.t; `: Fernande of F 6 • l : • r