560 NE 93 Sty
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date e22 0/Job Address (.56 41 ' ' 57 Tax Folio I/—.3 2/Z- P9—
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant 4,0774)47 x/
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Owner's Address 6 O X.76 / � /�/ 7 r r 33/38 Phone c .P�5 7
Contractin Co. J7�J /f Address / e,/
Qualifier Phone Y T 265) 7
State # /L- Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING
WORK DESCRIPTION t0,2_
t b /2 / (/6 14) / e bvt010
Square Ft. / 6 0 / Estimated Cost (value) e/ 2
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 1 applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
FEES: PERMIT
APPROVED:
Zoning
Mechanical
2Z 0/
or Condo Preside r
Notary as t. • er . or C3ndb1 i .' BiSi SSE' • Date
My Commission Exp es: GLADYSS J VILLAR
NOTARY PUBLIC STATE CF FLORIDA
COMMISSION NO. CC714103
MY COMMISSION EXP. MAR. 1,2OQ2
RADON
Xv 7 Z7
4 2/.1-0/
Build'
Plumbing
Notary : to Contract
My Commission Expi
Electrical
Master Permit #
NOTARY BOND 300
ENCE SIGN
44 ' 6=7/4/
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ignatur
actor
e ( u P 2 Y/9 69.4`
or
es: GLAD s VII.1.AR
F FLORIDA
NOTARY PUBLIC STATE O. I:C,G?
COMMISSION RIO. CC/14103
COMMISSION EXP. MAR. 1 7002
z ..
Structural Engineer
• a�
z
Date
SIGNED, SEALED AND DELIVERED in the presence of:
S horeJ
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 - 2382
Telephone: (305) 795 -2207
Fax -(3051.756 -8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
WHEREAS, ,4Nr( -ICON y `Il 1 l EYZ0 "( Y- , hereinafter referred to as the Owner of the
(owner)
following described property:
Legal description /folio#: (I 3Z06 -0/ (Oj 0
Lot Block Subdivision
Tax Folio #:
requests permis n to install:
Asphalt, oncrete brick pavers
[ ] Landscaping
[ ] Other
within the public road right of way of (56 v 416 9 3 At /l/ij _ �. �L' • 3 3 j 3 6
(address)
IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows:
I. To maintain and repair, when necessary, the above- mentioned item(s) installed within the dedicated right
of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said
items within public right of way including restoration of street by reason of the Owner's failure to do so,
such expense shall be paid by the Owner or shall constitute a lien against the above described property
until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or dade County harmless from
any and all liability, which may rise by virtue of permitting the installation of these items within the public
right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days
notice by the Village to do so. Failure to comply with this notice will result in the Village causing the
item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all
costs incurred in the removal and disposal of the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and
shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such
time as this obligation has been canceled by an affidavit filed in the Public records of Dade County, Florida
by the Village Manager of Miami Shores Village (or his fully authorized representative).
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE is ZZ day of 8 . 2 /
/� PPe° t-f
M iami Shore�
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 - 2382
Telephone: (305) 795 -2207
Fax: (305)_756 -8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
WHEREAS, ! till i`i-0&! l� `T1 i l( a (`! , hereinafter referred to as the Owner of the
/ (owner)
following described property:
Legal description /foliog: ( / - 3zo6 -�/ /060
Lot Block Subdivision
Tax Folio R:
requests permis n to install:
Asphalt, concrete, brick pavers
[ ] Landscaping
[ ] Other
within the public road right of way of (5 ilE 9 3 Al /t/ltl -vv ( r . ? 3 13 6
(address)
IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows:
1. To maintain and repair, when necessary, the above- mentioned item(s) installed within the dedicated right
of way. lilt becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said
items within public right of way including restoration of street by reason of the Owner's failure to do so,
such expense shall be paid by the Owner or shall constitute a lien against the above described property
until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or dade County harmless from
any and all liability, which may rise by virtue of permitting the installation of these items within the public
right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days
notice by the Village to do so. Failure to comply with this notice will result in the Village causing the
item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all
costs incurred in the removal and disposal of the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and
shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such
time as this obligation has been canceled by an affidavit filed in the Public records of Dade County, Florida
by the Village Manager of Miami Shores Village (or his fully authorized representative).
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE
2h
is ZZ day of / 8 . Zoo 1
SIGNED, SEALED AND DELIVERED in the presence of:
2,
(owner)
pKW tu7fy
n Pf o4ctf