140 NE 93 St (2)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.
Disapproved
(Signed)
Owner's Name and Address..
Registered Architect and /or Engineer
Name and address of licensed contractor
Locatio nd legal de iption of lot to be built on:
Loa 'it 7
Street and Number whwork is to be done
State work to be and urpose building (by floors)
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of fo}jpdation -.0 Roof 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 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- •.ntractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the si of he work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontra & tors, n .rk o be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA, 1
COUNTY OF DADE. J SS.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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,
therein by him stat ` e , true.
Permit No 2 U Date 2.Z ' Read, Sworn to
MIAMI SHORES VILLAGE
Subdivision
Chairman
Member
Member
Council Approved
� ate �/� / r,,li f`4✓
�r( Chi e� 4 -4 IQ r
q. -. - 40 ) Street
• P �L�
PLANNING BOARD DATE
and Subscribed before me.
to me well known,
and that he did sign the same, and that all facts
Notary Public, State of Florida
My Commission Expires
Member
Member
Member
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.
‘s
Date !_-/ Job Address 1 / e W / ) 86T Tax Folio // J DI Al jiff 6
Legal Description
0 4 hi c . 3 (1a ' l
ff (
Owner / Lessee / Tenant � 0/' 4.,i) Master Permit /P -198ie
Owner's Address //e W %g S Phone 75
Contracting Co. 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
RK DESCRIPTION lal?1-• (2e751) 51 - \G4 UDOCD kfl.A. ? P-(\i QC"
Square Ft. U N f T Estimated Cost(value
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 stated. J.,
Signature of owner and /or Condo President Signatur o 4kag r or Owner- Builder
Date: Date:. X 1 9,9,
Notary as to Owner and /or Condo President
My Commission Expires:
** * * * * * * * * *
FEES: PERMITt A DO RADON
APPROVED:
Zoning
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Mechanical Plumbing_
NOTARY S7re
Fire Other
Buildin
N: ary as to Co � • �'' /ty llt
Commission E f .17 Ma OC197545
,c
JOSEPHINE CHOW.
TOTAL DUE
**
t Electrical
Engineering