275 NE 92 StOwner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor
STATE OF FLORIDA
COUNTY OF DADE.
Permit No.
Disapproved
(Signed)
l ss
Vr11
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 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.
a alwn,
New Building Remodeling Addition
ltd 4oco 2. -/> c-
Location and legal des riptio pf lot to be built on: p�
Lot I v /e ' lock 0 Subdivision in Lee � "/ P
2".25r /v £ 9
Street and Number where work is to be done j �
State work to be done and purpose of building (by floors), state exterior colors (submit samples) l" ° GY / �/ ws (-L7)o c; )
C t e-- SQL /Pa �� r / C ( CeK c� mar
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvementsS D Amount of Permit $
66
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
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 subcontractors 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 appeared
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.
Date
Date
PLANNING BOARD DATE
Date
No.
1 , 5,5- 7
Repairs No. of Stories
Read, Sworn to and Subscribed before me.
Notary Public. State of Florida
19
Street
� 92 --
and for no other purpose.
to me well known.
Building Inspector My Commission Expires
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 far, inspection or faulty materials and/or workmanship.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date i / V Job Address 2 21 „4/1 -- 90? `I!. Tax Folio
Legal Description Historically Designated: Yes No ;K
Owner/Lessee / Tenant /�� /� ,- f X6 e. o
" ••;,-
Owner's Address 2 75 /t. C 9,2 =/ '4 e." JA,div, Phon('os) ).13 S 74J
Master Permit # y7,,zab
Contracting Co. J ��.• , . �� , ( / �m��� � 7 Address a 71 ,- f' 9' =' J '
Qualifier SS# Phone 1 )5
State # (6G QS 7 y 2 j Municipal # Competency # Ins. Co.
Architect/Engineer A 41 Address
Bonding Company 2 Address
Mortgagor A- 0 Address
Permit Type (circle on UILDING LECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
i
WORK DESCRIPTION / e h c a ce, ►., ��` i .�' p ra )1.7 2 4
Square Ft. Estimated Cost (value) / SU
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.
Notary as to Owner and/or Condo President Date
My Commission Expires:
Zoning Building
Mechanical Plumbing
*e
Signature of owner and/or Condo President Date Signa of Cont or or Owne ui r Date
OD
as to Contra
My Commission Ex
fires: GLAUYS) vILLAR
NOTARY PiJ13UC5PATE OF FLORIDA
COMMISSION NO. CC714103
MY COMMISSION EXP. MAIL 1 002
MV
FEES: PERMIT �— RADON C.C.F. ' 6 0 NOTARY � BOND
6� ms '
APPROVED: TOTAL DUE J
Electrical
Structural Engineer
Date