PAINT PERMITSDate 1 7 C`" Job Address
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Permit Type (circle one): BULDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
(4/:1 E - \ - ec1 D C" I1 b t.I _ (L /1 - 4r r ►
WORK DESCRIPTION
(1 c c cL
Square Ft. Estimated Cost (value) /) oy
I ('
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date Not as to Contractor or Owner - Builder
My Commission Expires: My Commission Expires:
FEES: PERMIT 2l� '
RADON
Signature of Contractor or Owner - Builder
TOTAL DUE
Date
Date
6.3 /�( O(/ S Tax Folio
Legal Description Historically Designated: Yes No
/ Tenant CON
\J (� � r eCtA Gr. Master Permit # 4 /0 7 3 g
Owner's Address l93 pi E \lSA off" ► Phone �5 1- 3 (e j ' o,
Contracting Co. 0 636\ Address
Qualifier SS# - Phone
State # Municipal # Competency # Ins. Co. _
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
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 abov -named contractor to do the work stated.
C.C.F. '6 NOTARY s BOND I V'S
APPROVED:
Zoning Building 1 � /re Electrical
Mechanical Plumbing Engineering
Permit No
Disapproved Date
(Signed)
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 f , , -c � r /' , 19
Owner's Name and Address 4_ :^_., �__ ____ _______�____w No Street
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 i s 1 1 . ` 1 ° ' . .^ � - ..< a
State work to be done and purpose of building (by floors)_„ _r' "� ..........'"47;
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind undation Ropf 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 pennit 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)
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-
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.
PAS- re - _7 Date t ° f
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
cling 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.