373 NE 92 St (8)Date / » Z °® 1 Job Address 373 i%) ( C1 , - f- Tax Folio 11 /206 Q! 3 - to yob
Leg! al s Descrip 'on ` V G[ 1 t Z tC O- C. t� 7
/ Tenant M wit= -- A- CA-W1 led e Z
Owneis Address 3 .' 3 N 2 S1a' brf Phone (), ` '7 S I • Z 71 t
1
Contracting Co. Address
Qualifier SS#
State # Municipal # Competency # Ins. Co.
gineer / + R — 2 *M.e6 �Z — ' Address 3 7 S 4 9.7 7 kr
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
fl/ ("W "W Ti 34 C44._ ( wlrvt. rt. A� f / A -
it 5-'v d t-er Wiredv, f r.^41c Ald(A2-1 / 0
Square Ft. S f O'Ze A wttcH Estimated Cost (value) 00 g
WORK DESCRIPTION
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
construct • .. d zoning. Furth i : e, I authorize the above -named contractor to do the work stated.
/'1
Notary as
My Commission Expires,.:
Mechanical
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
-077AkZ0 bf 0 0
FEpSPERMIT 60 t D 6 RADON
APPROVED:
ire /a/A/
Zoning C /J-f' -7 q Building
t,K 0
Historically Designated: Yes No
Master Permit # 5 Q 0
Signature of Contractor or Owner- Builder Date
Date Notary as to Contractor or Owner- Builder Date
My Commission Expires:
C.C.F. NOTARY 5, 0 BOND 4 S ,. 6 Ca
Electrical
Plumbing Structural Engineer
Phone
TOTAL DUE
STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affiant, VNI P4 GA M Pa t L L , does hereby attest that the
(property owner)
Gil I LSO NJ t /12t
attached survey, performed by
performed on ' 2 1 • 2 00 B , is an accurate representation of the existing conditions and
(date of survey)
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the
property without first providing a survey less than six (6) months old. The Affiant, as property owner, further
agrees to remove or obtain permits for any structures which now may exist on the property which are not
permitted or which may violate zoning or building code regulations. The Affiant further understands that the
existence of any such structures may affect final inspections as applicable to this or other permits..
Further, Affiant sayeth naught.
Witness(sign and print)
SWORN TO AND SUBSCRIBED before me thisi, day of ( )
Affiant is personally known to me, produced as identification.
SIiord Vi�La.�e
AFFIDAVIT
(name of surveyor's company)
Witness(sign and print)
TILDING ❑
- ECTRICAL ❑
• UMBING ❑
)OFING r ❑
vner of
ilding
tect
ntractor
Builder
gal Lot
scription
ldress of
ilding
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE.
PERMIT N? 6055
31
FLORIDA,
DATE 195
Contractor's -
License No.
Work to be performed under this Permit
Subdi-
vision
Value of 11 Amount of
Project $ I1 Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
efor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans
=wings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
e if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
nted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
staining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
ne by his agents, servants or employees.
Signed. BY
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance wii_s all ordinances and regulations
rtaining thereto and in strict conformity with the plans, drawings, statements or specifications submit id to the proper authorities of Miami Shores Village. In ac•
pting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
w.�
BY AUTHORITY
6