PAINT PERMITPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 7-67-r4 Job Address 9 70 NE 9 2 Street
Tax Folio
Legal Description Historically Designated: Yes No
Owner/km=4MM= LOUISE GAINEY Master Permit # t- zyi ,S
Owner's Address 970 NE 92 StrpPt Phone (305) 751 -5488
Contracting Co. /1` 41/L (EP— Address
Qualifier SS# Phone
State # Municipal # Competency #
Architect/Engineer Address •
Bonding Company Address
Mortgagor Address No cis E._
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FE
WORK DESCRIPTION C
TkTii " e�'�f'ifi/7`i�G2 IgE9CreA7r - _NUTmm,_° —S, Q&MS.
Square Ft. Estimated Cost (value) 1 0?)
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 construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Signature of owner and/or Condo President Date
FEES: PERMIT L,/2. RADON
gnature of Contractor or Owner -B>6 Date
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner- Builder Date
My Commission Expires: My Commission Expires:
C.C.F._ 4 5 NOTARY , ` nc) TOTAL DUE
APPROVED:
Zoning Building Electrical
Mechanical Plumbing Engineering
- 1)
Name and address of licensed contracto
STATE OF FLORIDA
COUNTY OF DADE.
J SS.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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.
ti
Owner's Name and Address ( �� C�� ,� � - :' x l °� A C
Registered Architect and/or Engineer (` 1r) 11 ''+1t` 1 1 4- 6 1 6„l e',,(
Street and Number where work is to be done ",1 D fn r' \k•
;57-Jf8e
Date ! { iD 19)
No.`) • Streett - J /(--•
Location and legal description of lot to be built on: /f fJ q ' /1
Lot /td! / / ^/ 5 1 Block Subdivision ,9i A ' f L F:lYif.LPrl� y` (.t% „� // 346 / 46
�,g�tate work to be done and purpose of building (by floors). state exterior colors (submt amp/ s) � C ✓r ee, '•� w jr1 (01 l 1' (' - C-�.. % :‘: � f• . \ L i k.a ° i
- j ;, . �, %)c - '''11' ^0,1_ )�', " ""- . • YV rlc, �
0_ " ' ?∎LI ,'iv1C • I� `.,r�-'� �U14'1 _•� r5 . ' c -.� - A V I " �'1Q IC�.0 i 1`, stir)!:
r i
d•
a ■! r -} Q X- 1� \: ,,,,, v ,, c I e C� `�'TEJP I C11� i a (Yl l l C� � r 1Y.1 9 Q , and for no other purpose.
New Building Remodeling Addition Repairs No of Stories 1
To be constructed of Kind of foundation Roof Covering
‘e 6V
Estimated Total cost of improvements S 5tt C
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 plans and specifications for said building. All notices with reference to the building and its construction may be sent to
Amount of Permit $
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons 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 the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors on work to be performed
under this permit, as are licensed by Miami Shores Village.
_
Remarks (Signed) g. 2 t.c1� � -a [fir% —111. C P.D)
4
Before me, the undersigned authority. a notary public, duly authorized to administer oaths and take acknowledgments. personally appeared
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 the foregoin: application. and that he did sign the same. and that all facts therein by him stated are true.
Permit No.
Disapproved
(Signed)
Building Inspector
Date
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
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 525.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.