PAINTPERMIT APPLICATION FOR MIIAMI SHORES VILLAGE
Date Job Address X ;�2 3 0 4)& 9J '1/2 Folio
Legal Description / ' Historically Designated: Yes No
Owner/Lessee / Tenant X 4_44 '/72 CA/ei,-i -c 0-0-2' Master Permit # j 3 fc
Address
ltd
Owner's Address Phone, ' 3 7,5 7 37
Contracting Co. Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Address
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one) BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
, a ,. / . 77c/ 7 " 7
WORK DESCRIPTION L1� - � (////1
Square Ft. Estimated Cost (value)X l 3
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 perfonned 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.
OWNERS 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
My Commission Expires:
FEES: PERMIT
RADON
Notary as to Owner and/or Condo President Date Notary as to ontractor o
My Corission Expires:
C.C.F. (•■9 D NOTARY 5
<C
e of Contrac •r • er- Builder Date
US�S % V6 Z6�0 zoo
/
Own a s' # 7 .-. y 5 , , F ate
rYS J VILLA
ti
ti'k,'OTARY PUBLIC STATE OF FLORIDA
COMM S&LON NO. CC 7141a3
_ MY COMMISSION EXP. MAR. 1 ;kt2 j
Electrical
BOND
TOTAL DUE
APPROVED:
Zoning Buil
Mechanical Plumbing Structural Engineer
086
,gip} cc t. s .aiaoy n:.we 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.
� Date a/ / 19
Owner's Name and Address /ez r / may � /�/ Z7 / No. 70 3 0 Street /1/ F S/
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot
New Building Remodeling
STATE OF FLORIDA
COUNTY OF DADE.
Permit No.
Disapproved
(Signed)
J ss.
Building Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Block Subdivision
Street and Number where work is to be done /62 0 /06
A , 14 S // 3 ,2 o5 J
� j
State work to be don and purpose of building (by floors), state exterior colors (submit samples)
../. 7 X 7
and for no other purpose.
No. of Stories "'
Addition Repairs
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements S c 0 e,7 Amount of Permit $ 7
Zone cubage required Plan Cubage
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 employ only such sub 'f' actors. on work to be performed
under this permit, as are licensed by Miami Shores Village.
Size of Building Lot
Distance to next nearest building
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
Remarks (Signed)
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 foregoing application, and that he did sign the same, and that all facts therein by him stated are true.
Date_ntb /O �/ Read, Sworn to and Subscribed before me.
Date
757 23/7
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 $25.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
MIAMI SHORES VILLAGE. FLORIDA
❑ PERMIT N? 6364 Contractor s
License No.
DATE t 195_1!
❑ Work to be performed under this Permit
Owner of
Building F
Architect
Contractor
or Builder • `�,
Legal Lot
Description 1 Bl
Address of
Huilding
Subdi-
vision
Value of - I Amount of
Project $ I! 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 application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed.-ia 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 ar in the statstfients or specifications and that he sumes responsibility for work
done by his agents, servants or employees. s®
Signed.r? . •t. _,•
In consideration of the issuance to me of this permit I agree to perform the work covered herednder 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 ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
CONTRACTCR OR BUILDER
INSPECTOR
BY AUTHORITY