PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date � r Job Address /6 // NC 7-2 cf . ' Tax Folio
Legal Description Historically Designated: Yes No / l
Owner/Lessee / Tenant Oa_ r e 5 t?'./(.._ Master Permit # k0 3 ! - 3 7
Owner's Address /6 / /v 6 ' SI ' Phone .5 r 7-r7 - 5
- 3,.. , 3 -- q3S- ei66
Contracting Co. b h 0(011.
Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Address
Architect/Engineer
Bonding Company Address
311
Mortgagor Address
Permit Type (circle one): ; UILDIN ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
I
WORK DESCRIPTION 63d 1 cvf' phi l t\-+ -- /A) ! Lt S C- 1 t S o P - A �S
resident
Signature` f owner an
-
/1 =
Date Notary as to Contractor or Owner- Builder Date
My Commission Expires:
APPROVED:
Zoning Building '" / I / �' Electrical
Mechanical Plumbing Engineering
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.
F Rt . Cie) 7 0-4 E
R egistered Architect andior Engineer
-Name and address of licensed contractor �.7///
Location and legal description of lot to be built on:
Lot O1 �j
I � Block 4�/ Subdivision 70 / I k10,1) . 1 / J',Z�� /`� g/ fl 1
Street and Number where work is to be done /41 ,v F
- ' wner's Name and Address
1 .,---<ate work to be done and purpose of building (by floors). state exterior colors (subfnit samples)
✓0 s — , EEC )1) t-- � ►s�-) o,
( ids' 1 4, add
New Building
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLAICATION FOR BUILDING PERMIT
Remodeling
Addition Repairs
Date / 19
No /6 / Street RI
Il\-1 E)t f od n ;
OP- P-�tPJCF [CS -r
No. of Stories
To be constructed of -J O O Hind of foundation Roof Covering
‘-1 mated Total cost of improvements S 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 plans and specifications for said building. All notices with reference to the building and its construction may be sent to
and for no other purpose.
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.
1 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.
Permit No. ( e 4' Date e/31/ fa Read. Sworn to and Subscribed before me.
Disapproved
(Signed)
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 $25.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and workmanship.