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MECHANICALPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address r ,Y6 ?.5 -71-12. 51 Date Legal Description Owner / Lessee / Tenant 04. S.4wi S/94/ Owner's Address /o S 3 /I/E 95 Contracting Co. Master Permit # ` Phone 5',36. C��N�'n� /4 '2 1,74 Address /n 3- CS 7/ 3 ST Qualifier igAl CH/ /" State #(11Nc.� Municipal # Architect /Engineer Bonding Company Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING APPROVED: Zoning Mechanical WORK DESCRIPTIO Square Ft. Estimated Cost(value) IN 1 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_cnmpliance with ' =11 applicable laws regulatin: .struction and zoning. Furthermore, I author ze the above - - contractor to do the work s Signature of owner and /or Condo President Date: Notary as to Owner and / Condo President My Commission Expires: OFFICIAL NOTARY SEAL SUSAN J LEFKOWITZ NOTARY PUBLIC STATE OF FLORIDA ** * * * * COMMISSION NO. C(1155756 * MY COMMISSION EXP. MAR. 14,199$ FEES: PERMIT 91s/ RADON C.C.F. ) Fire Building Plumbing Tax Folio Phone S'b5' /7 Competency # Ins.Co. Address Address ROOFING PAVING FENCE SIGN r`Ir -, ' of Contractor or Owner- Builder Date: /` ri m ..,, Notary as to Contra itlemmIO N NO. C ccsg�� 1756 My Commission Expires: �� j5i / gam OFFICIAL NOTARY SEAL SUSAN J LEFKOWITZ NOTARY PUBLIC STATE OF FLORIDA * * * * * * * * * NOTARY TOTAL DUE f 60 Other Electrical Engineering Bulletin IDA 33138 for? A( - �- To Inform You of the Activities of Your VILLAGE Police - Fire: 759 -2418 MIAMI SHORES VILLAGE COUNCIL 1st and 3rd Tuesday of each month 4:00 P.M., Village Hall Elwood Jones, Mayor Raymond 1. Clement, Councilman Dean R. Claussen, Councilman Marjorie A. Dunn, Councilwoman Howard .1. McLaughlin, Councilman MEETING DAT PI 2i 7: John W. McIntyre, Village Man. Ann Vigneron, Village Clerk Gerald McFarlin, Finance Direct. Thomas H. Anderson, Village Ai Wayne Thurman, Police Chief MIAMI SHORES VILLAGE, FLA. k. JOB If 'L ADDRESS (O r � ��t REMARKS• 6 N_ 114 INSPECTION -- CQid-e r F® . ?6, TIME READY Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing 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 budding during progress of the work. Owner's Name and Address Name and address of licensed contractor Disapproved (Signed) MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT. APPLICATION FOR BUILDING PERMIT Registered Architect and /or Engineer /244/4: Building Inspector Date. /. eb' ... _. IBS "No. . Str ✓��.'._ X/e.e >.2 — e C 89oz, 4e Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done `�N e 9r Remarks (Signed -___" Notary Public, State of Florida My Commission Expires _ / /144// be done <, �' a d p ose of building,(by floors) .....i % 4' , ' ' 1 r �.., ! s . ' r — State work 'S 4141. &_ �©,,e • ( ? t / /4.2,./. %.x -P s). -_ _..._ ..._. and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation �, / Ro of�vering Estimated Total cost of improvements $ !a 09 : , Amount of Permit &. /.Z Zone cubage required _Plan Cubage Distance to next ne.uest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the 'Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Sup element, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hint in the work to be performed under this permit; and will post or cause to be posted for ins ection on the site of the wo such public notice or notices as are required by the Act. The undersigned agrees to employ only such su ntractors, on work to b rformed under this pennit, as are licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. ss Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared 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. Permit No.. � 7 Date.. r �� _ Read, Sworn to and Subscribed before me. PLANNING BOARD DATE Chairman Member Member Member Member ...... _. ----- _ -_ - --_ - -•-- .._.__ Member Council Approved _ Date Disapproved Date NOTE: A charge of $1.00 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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.