395 NE 92 St (10)4/
STATE OF FLORIDA,
COUNTY OF DADE. ss.
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re-inspection fee of $1.00 will be charged
materials and /or workmanship.
MIAMI S H
Chairman
Member
Member
Council Approved Date
ES VILLAGE
BUILDING IN TION DEPARTMENT
PPLICATION 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.
State work o be do e and purpose of building (by floors
tazIkC 3771-;1__
Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor F6a
Location and legal description of lot to be built on:
Lot Block Subdivision
9
Street and Number where work is to be done
J '
Date / P ,19a
No. - -- f' 4Street - -- - 6r $ !( 4 --
PLA ING BOARD DATE
Read, Sworn to and Subscribed before me.
and for no other purpose.
New Building Remodeling Addition _ Repairs No. of Stories
To be constructed of Kind of foundation n Roof Covering
Estimated Total cost of improvements $____.4 `"' 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 - 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 th work such public notice
or notices as are required by the Act. The undersigned agrees to employ only ch subcontractors, on work to bperformed 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 ap-
peared
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 th foregoing application, and that he did sign the same, and that all facts
therein by him stated � aree true.
Permit No 2 3 `T '7 Date_
Disapproved Date_
(Signed) ��
Building Inspector
Notary Public, State of Florida
My Commission Expires
Member
Member
Member
Disapproved Date
making corrections or changes to this application after approval has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty
BUILDING
ELECTRICAL
PLUMBING
ROOFING
MIAMI SHORES VILLAGE, FLORIDA
PERMIT
Owner of
Building
Architect
Contractor
or Builder
Legal Lot
Description II Bl
N9 7349
Work to be performed under this Permit
Contractor's
License No.
DATE
19
L
Subdi-
vision
Address of _ - ,. ,- k Value of — I Amount of
Building 4.. Project ______ 4 ', 1 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 applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time 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 granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
C. 0
Signed. G•' " "'" ' INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In as
cepting this permit I assume responsibility for ell work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER BY AUTHORITY ��sot
Date? 4/7 Job Address Ws c?2 Tax Folio //j�6 � 6#7&
Legal Description e �`� 1 I I
Owner / Lessee / Tenant (/ / , h6� /�U
Owner's Address 3 7 f'
Contracting Co.
Qualifier L � -' -ice SS# Phone S5(
State 1r~ 02-90 Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBIN MECHANIC ROOFING PAVING FENCE SIGN
/ o
WORK DESCRIPTION
Square Ft. 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 AFFI VIT: c: tify that all the foregoing information is ac
be done in plianc= w\h all applicable laws regulating construc
authorize \contractor to do the work stated.
iCENCIa J ' c,
M A bC �.
G IPIRE S : ; y 28, tc
No ry as to Owner
Signature o
Date:
My Commission Exp'res:
/ ,/ /
FEES: PERMIT 7I�2� RADON C.C.F. //_5 NOTARY TOTAL DUE 7/ `O 2 v o
- !40.00 Lt"1
Fire Other / ,61
Building Electrical
** *
APPROVED:
Zoning
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
(tP &i2 &,vim / ,7oy /v(
l
*'
Address
71 )5"Xw/
5 M7
Master Permit 1
Phone
2322 GO. 75
yoo
all work will
Furthermore, I
Signature of Contractor or Owner- Builder
Date:
AP" ..w........ INOC CIO JOSE GONZALEZ
' MM!SS!CN li i•C
tary as t
My Commission
der
Mechanical01 flP1umbing Engineering