FENCE9
Owner/Lessee / Tenant
WORK DESCRIPTION
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address / 4 /Y f _ 7) (4 Tax Folio
1 1 0 .1.,/ �` {e• / Historically Designated: Yes No
V 9 L-
OWnq
Owner's Address
Contracting Co.
Qualifier
State #
Architect/Engineer
Bonding Company
Mortgagor Address
Municipal #
Notary as to Owner and/or Condo President Date
My Commission Expires:
Q • 0 £ Master Permit # Lific7 Z
. 5/ Phone 7(57 M
SS# Phone
Competency # Ins. Co.
Address
Address
Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
(J) J PA r ve ri
Square Ft. Estimated Cost (value) 711/ `e / fl ((`t (/
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 AFFID • 1 T: I cert ify .11 the foregoing information is accurate and that a ork will be done in compliance with all applicable
laws regulating coon and .. Furthermore, I authorize the above
named co. • • to do the w,e
,
gna of owner . .i.r ondoPre ate
71 a .'of P. Oor or Owner- Builder Date
Notary as to Contractor or Owner- Builder
My Commission Expires:
Date
FEES: PERMIT i- RADON C.C.F. / 60 NOTARY , TOTAL DUE "T.) •
APPROVED:
q1 Zonin g Building Y Electrical
Mechanical Plumbing Engineering
:9.. v■.a - 34(16gQ4'
JKAI: unit=s, r ia, 33134 THOMAS J. KELLY, INC.
FDADQ re ;44.1899
elm! s -aae• LAND SURVEYOR
IAx . 441- 4494
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SURVEY N0,2 ± r`-
3HEET 2 . OF 2
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Co A vas 8 C F FL L L A. -SUITE ' 1p4 T W
DADE( (305)444.10 *
enwD: (306) 110• 11210 FAX: Mel 441 - •4114
SURVEY T . l" •
SUBDIVISION ALA/- -1 j ' /-10
ACCORDING TO THE PLAT „THEREOF A8
PUBLIC RECORDS OF f Pe
DATE : -( ° .�� )4
LOCATION SKETCH SCALE: I
a FLOOD ZONE : .r
ac
r•
OMAS J, . KELLY, INC.
ECIRDED IN PLAT BOOK Ne, . _ AT PAGE No. ?
COUNTY, FLORIOA, L i =gar poa) 12.49 I
FOR, c\Ia,1c gnrcl
kl .:_.... ,1 " ,
11 1
I Yr 1'3 xO .21
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LAND SURVEYOR
SURVEY N0. 9�1'l:$O7.
SHEET... -L. OF. -z
BLOCK
17 -• (:), Ili). 46'0 N,E, 3P.b c r�
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THIS IS NOT A FLOOD HAZARD ZONE
THIS 18 A FLOOD HAZA J � C IONE
COMMUNITY PANEL No.,. '''
PANEL No. - � SUFFIX : -� DATE OF FIRM 3- z ' "m----
EASE FLOOD ELEV. 4/4 LOWEST FLOOR ELEV. A, HIGHEST ADJ. GRADE' Mme•
NOTE : UNDERGROUND ENCROACHMENTS, IF ANY, NOT LOCATED. t JCP- 1c1 f
!hereby certify that Mds sketch of survey of the above described property is ITO and correct to the best of my knowledge and
belief as surveyed and platted under my friction. l further osrtify that •this survey meet the minimum requirements adoppted by
the ' • clety • eslonal Land Sury °n and the Florida Land Title Assoolatlon and also CH 21 H1+8 F.A. code. There
are n • en • c Keept assho7 ,
` / Notes: I. If shown, bearings are to an assumed meridian (by plat )
r " • ' � ' 2. If shown, elev bons are referred N.G.V. Datum 1929
, ,gip 4 Oote of Fiel. Work 3. This is a land survey.
tesslonol Land Surveyor # 486
(Nate of Florida Closure above 1 :11500
C
(Not Wild Unless Imprinted With An Embossed Surveyors Seal) M1, � SCALE 1 ° s /'S
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