PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 611 Job Address 3 02 5 f V. E. c i 3 Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant .bEAA pA 8FL Ln so
Master Permit #
Owner's Address 10 $ atiz., 4 dipe . , 44j. G,O S, 6a.Q /6.4 4 Phone (.3o S ) 86 (- ( s-
Contracting Co. yyIVF t2 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
WORK DESCRIPTION
. f12 ?M tax t t
Square Ft. Estimated Cost (value) 1, S'OQ
(---7 33
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.
Signature of owner and/or Condo President
Notary as to Owner and/or Condo President Date
My Commission Expires: My Co
FEES: PERMIT L .�� RADON C.C.F. / v NOTARY S BOND
APPROVED:
Zoning
Mechanical
Building /
Date Signature of Contractor or Owner-Builder
No R te''' oDEH61
^ �; ion it ' A
ME
YI R O �� MY D C 7 EXPIRES
OfP�
Electrical
Date
Date
7�1 -C7
TOTAL DUE ' ' v
Plumbing Structural Engineer
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 regula-
tions 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 1 l ' �_ , 19
Owner's Name and Address $ No. _ Street ' e
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot____ Block Subdivision 1 " � V
Street and Number where work is to be done
State work to .,done and pur ose of building (by floors)
t.
New Building____________ Remodeling
To be constructed of Kind of foundation _ Roof Covering
Estimated Total cost of improvements $ Amount of Permit $
Zone cubage required Plan Cubage
Distance to next nearest building Size of Building Lot
STATE OF FLORIDA,
COUNTY OF DADE.
and for no other purpose.
Addition_ _ __ —__ ______ Repairs No. of Stories__ ____
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 - 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
0
(Signed) A
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
Disapproved
(Signed)
Building Inspector
Date Read, Sworn to and Subscribed before me.
Date
Chairman
Member
Member
Council Approved
NOTE: A charge of $1
the Planning Board.
A re- inspection fee of $1.
materials and/or workmanship.
PLANNING BOARD DATE
Member ---
Member
Member 7
Date Disapproved
.00 will be made for making corrections or changes to
00 will be charged when such re- inspection is made n
Notary Public, State of Florida
My Commission Expires
—Date
royal has been obtained from
ice for inspection or faulty