62 NE 93 St (9)Date
PE
--- '2/ Job Address (7// AA:- -;`7"
Le al Descriptiora
Owner / Lessee / Tenant (._&:),,„) f t
Owner's Address
• :/
•
Contracting Co. Address
Qualifier SS9 Phone
State 1 Municipal P Competency .Co
Architect/Engineer
Bonding Company
Mortgagor Addre3s
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAV::NG :?ENCE SIGN
WORK DESCRIPTION - rl:¼J7 'i\l" -
Square Ft. Estimated Cost(value)
WARNING TO OWNER: YOU MUST RECORD A NOTICE OP COMMENCEMENT AND YOUR :FAILURE TO DO
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY ( F 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 instalaation as indicated above, and
on the attached addendum (if applicable). I certify that all work will be perforrae o 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 Ti 012K,
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. 1 I
authorize the above-named contractor to do the work stated.
Signature of ownez- and/or Condo President
Date: :, ;,1),/
Notary as to Owner ncktorPeotrM
y Commission Expiriq2, -- 1/41
* * •'z
*OF *
* * *
EES: PERMIT /C RADON C.C.F.
'PROV3D:
MIT APPLICATION FOR MIAMI SHORES VILLAGE
b/PtegidtiltZEAS.
Notary as to Contractor or Owner-Builder
MVP:
NUMWEA
!XP.
S,16C 7 1 *
* * *
NOTARY
Fire
Zoning Building -f-**
Mechanical_ Plumbing
Tax Folio
Address
,Address
Signature of Contractor or Cwner-Builder
Date:
My Commission Expires:
• . I
rf:aster Permit 4P__
Phone
•
TOTAL DUE
ether
Electrical
3ngineering
**
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect _
Contractor
or Builder
MIAMI SHORE::S VILLAGE, FLORIDA
PERMIT N? 5070
Work to be performed under this Permit_ _—
CONTRACTOR OR BUILDER BY
DATE
Contractor's
License No.
13y
194_
Legal Lot BI. Subdi-
Description vision
Address of ' "Value of Anita of
Building* Project Permit
This hermit is granted to the contractor or builder named above to constrict the building or to install the e mipntent or dev ice d sc ihcd in the appli-
cation herefor in strict compliance With all ordinances pertaining thereto and with the understanding that the work will b. performed in compliance with any
plan,
drawing, statements or specifications that may have been submil :ed to and approved by the proper niuuio1p cl authorities. This Permit may be revoked
at any time if the xvork is not done in compliance with such ordinances or if the plans are changed without authori; ation. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes- the responsibility for a Lhorou,;h knowledge of the ordinances and
regu!ations 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 agent::, servants or employees.
Signed•
INSPECTOR
In consideration of the issuance to me of this permit I agree to p erform the work covered hereunder in compliance with all ordincuues and regulations
pertaining thereto and in strict conformity with the plans. drawings, statements or specifications submitted to the ;?roper authorities of :Miami Shores Village,
In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
AUTHORITY
BUILDING
'ELECTRICAL
PLUMBING
Owner of
Bniiding
Architect _
Contractor
or Builder
Legal Lot
Description
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
DA TE
PERMIT N9 5070
Work to be performed under this Permit
BI.
Subdi-
vision
Contractor's
License No.
Address of Value of Amt. of
Building_ Project i Permit
This permit is granted to the contractor or builder na:nec . above to construct the builCing or to install the equipment or d
herefor in strict compliance with all ordinances pertaining thereto and with the unders•:anding that the work will be performed
plans, drawings, sLaten or specifications that may have ben submitted to and appremed by the proper n uricipal authoritcs. 7111;
at any time if the work is not done in c o m pli a nce with such ordinances or if the plans are changed without Luthorization. A further cc
permit is granted is the understanding that the contractor or but: der named above assurueg the responsibility for a thorough k.nowlcch
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and.
sibility for work done by his agents, servants or employees.
Signed: By
INSPECTOR
A
,
BY At; I HOMY
• vb.
• 'cC.'crilm-c in the p.
:n compliance \yid, ;1.11..
PC1 may 1).'
Tt6ition iipou
r 3f the
th It he assumi s rcspon
In consideration of the issuance to me of this permit I agree to perform thc‘wolk cove.:ed hereunder in compliance with al o; (lin me us ;md re2,
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted :o the proper autlioriYes c \Einii S110 rc,
In acceptng this permit I assume responsibility for all work dona by either myself, my agent, servant or emp.oyce.
•
Application is hereby made for the approval of the detailed :totem-ant of the plans end s_aecificatioss herewith submitted for the budding or oth : uct ere hr r, •:r
described. This ao_olication is made in compliance and conformity with the Building Ordinance o1' Miami Shores Village Floridt.. and all provisions ref the l .,.r. , of t lu
State of Florida. all ordinances of Miami Shores Village and all rules end regulations of the Building Division of Miami Shores Village shall be comn'i d t.ith. v.hsthe r
he e.n specified or rot. A copy o. approved plans and specifications riust be kept at building ct.ring progrers of the work.
Owner's lame and Address
/ • J .L
Name and address of licensed contractor y •
Registered Architect and or Engineer
Location and legal description of lot to be built on:
Lot
Block
Street and Number where work is to be done
New Building .._ Remodeling
To be constructed of
Estimated Total cost of improvements S
SHORES TE,LAGE
I Tit.4I;DIN2 IINS:F=HON DE AIR`TMIEN'n
State work to be dune and purpose of building (by floors). state eta_rior colors (submit samples
�� .� _ - :if i _. ).. moda
l" •�' w
Subdiv::;:on _ % /
4 •
Kind of foundation
Addition. Repairs
_ Amount of Permit `
Zone cubage required _ _ _ Flan Cubage _
Distance to rant nearest building
Maximum live load to be borne by each floor
I hereby submt all plans and specifications for said building. All notices with reference to the building and it cc titre,. Ciro
Remarks (Signed)
Disapproved v Da
(Signed)
zz - Date
' / 1 %._✓ �l
_Size of Building Lot
My Commission Expires ._ _
Coy, i
DATE
_ . Street
d 1 / - 1„:" .
/:
Notary 'ublic. State of Florida
and ire.
No. of Stork
t
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons as an employer of Labor under the F:orid;! C+t:rkmrd -
Compensation Act, being Section 5966. Compiled General Laws of Florida. Permanent Supplement. and has complied with the provisions thereof. end t ;i1i1 reeuire siruL,
compliance from all contractors or sub- contr €ctors employed by him 'n the work to be performed under this permit: and will post or cause to be prrttc. for inspect: w1
on the site of the cork such public notice or notices as aro required by the Act. The undersigni undersign agrees to employ oil.; suc'i <_ubcontrccto,s. on v.or t ic• perfury.,: -:
under this permit, as are licensed by Miami Shores Village.
STATE OF FLOWDA
COUNTY OF DADh . } ss.
Before me. the undersigned authority. a notary public. duly au'_horized to administer ocths and take acknowledgments, personally uppear:d
and who. being by me first duly sworn, upon oath deposes and sa s that he is the
of the above described construction, that he has carefully Bead the foregoing application, and that he did sign the same, and that all facts therein by iIm stilt( d) cne ;rw
Permit No. j 4 ' / _ I Date f l Read. Sworn to and Subscribed before rr.e.
Building Inspector
PLANNING BOARD
Chairman Member
Member _ Vembsr
Member Member
Council Approved Tate Disapproved
NOTE: A charge of 525.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board
A re- inspection fee of S25.00 will be charged when such re inspection is made necessary by improper notice for inspection or faulty materials i:rd or s arlcmun"l:i+
..: • v:rl! !crone