1066 NE 94 St (9)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 2- 1 - 9 9 Job Address / b b N E 1 `7 S L J Tax Folio
Legal Description Historically Designated: Yes No
1 'n
Owner/Lessee / Tenant L- o (r r 1 `" l o c ‘ S Master Permit #
Owner's Address Phone 3S - 8 9 I- 3 O 3 1 e ./
Contracting Co. C Q ( r I ' ` o c c. r S Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION . ` �'` E xAr- . c
Square Ft. Estimated Cost (value) 2_ O 00.
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.
1
Signature of owner and/or Condo President Date Signature of Contractor or „O e - lder /! yl ` Date
it TY1 ,,
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner- Builder Date
My Commission Expires: My Comitssion�a :\ '.-, � infS' a .....
r' ,AY 11 .V,' .L+ y
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FEES: PERMIT V ...° RADON C.C.F.) • Ak ° NOTARY BOND U
TOTAL DUE 1� T
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APPROVED:
Zoning Building ` Z C 1 Z 1 L Electrical
Mechanical Plumbing Engineering
BUILDING ❑
ELECTRICAL ❑
PLUMBING ❑
ROOFING ❑
Owner of
Building
Architect
Contractor
or Builder
MIAMI SHORES VILLAGE.
PERMIT
Sign
N? 4343
FLORIDA
Work to be performed under this Permit
0 4 `!
DAT
Contractor's
License No.
19
Legal Lot Subdi-
Description Bl. vision
Address of j Value of Amount of /
Building ��� .' 4/ / : °'° Project $ Permit $ / � .,,,
r
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 in 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 • dinances and regulations
pertaining to the work covered hereby whether shown on the plops or drawings or i he statement�ff or specifications an • at he a =' • e sponsibility for work
done by his agents, servants or employees.
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work co ed hereunder in compliance with all ordinances and '� lotions
pertaining thereto and in strict conformity with the plans, drawings, statements or specification 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.
4 _ { • F ..
r
CONTRACTOR OR BUILDER BY AUTHORITY
APPLICATION FOR BUILDING PERMIT
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 not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Date
Owner's Name and Address.. No.,...... Street _ .....
Registered Architect and /or Engineer
Name and address of licensed contractor a l ti ! A `.
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
0 /
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ Amount of Permit $
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 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 pennit 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 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 tp be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed).
o
STATE OF FLORIDA,
COUNTY OF DADE. j ss •
Disapproved Date
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Notary Public, State of Florida
,19
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 a foregoing application, and that he did sign the same, and that all facts
therein by him tated arp t . _��. �,
Permit No.'.: . . �a //
�'.... Da te u ? Read, Sworn to and Subscribed before me.
Building Inspector My Commission Expires
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 81.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and/or workmanship.
Owner/Lessee / Tenant
WORK DESCRIPTION
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date q / / Job Address 066 J&J/T 9 Sr
L1 Pt ADD ) /,
Legal Description ,-i ' n 5 f AZ S
Owner's Address 1 066 79 57 Phone �S Y ffie/ -/p esf *97,
Contracting Co. Owl ". Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
FA A I 1,0 G- (-1(3 E X TE A f
Square Ft Estimated Cost (value) AO0
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.
Da a Signature of Contractor or Owner- Builder Date
Signature of owner and/or Condo President
Not as to Owner and/or Condo President ate Notary as to Contractor or Owner - Builder Date
My Commission Expires: My Commission Expires:
Tax Folio a 3 5 5
Historically Designated: Yes No ,/
Master Permit #
'
OFFICIAL NOTARY SEAL
RHODA V GELLER
NOTARY PiJ &L:C STATE OF FLORIDA
COMMISSION NO. CC493094
MY COMMISSION EXP. AUG. 20,1999
FEES: PERMIT /7 RADON C.C.F. g 0 NOTARY BOND V L;'
TOTAL DUE
APPROVED:
Zoning Building I l l f P Electrical
I
Mechanical Plumbing Engineering