1201 NE 94 St (14)"hr PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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Legal Description , "°
Owner / Lessee / T
Owner's Address
Contracting C
Qualifier
State #
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION ..S ^(,/�� � i /,r < ��'/ /,C�l j am / C %% e /.f
Square Ft. 6 .2
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 a applicable laws regulating construction and zoning. Furthermore, I
authorize the above -nam- � Ai t r• nr to do the nrl` stated.
• . CHURCH
ublic, Stye of F lido
FEES: PERMIT/ 1'
APPROVED:
enant • /��. � r /�/ �� ' c Master Permit It 333 5 '/'
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Municipal # Competency #
Sig.. of~owner and/
Date: / . /Ar VA.
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Type anJ nt. ber of I.D. produced:
' y Commission Expires:
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** * * * 113 DID NQI take*an oath. *
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Estimated Cost(value) cX
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Zoning (Building
Mechanical Plumbing
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Address
Phone
Ins.Co.
Signature of Contractor or Owner- Builder
Date:
Notary as to Contractor or Owner- Builder
My Commission Expires:
* * * * * * * **
NOTARY TOTAL DUE
Other
Electrical
Engineering
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THESE PLANS ARE APPROVED FOR
ISSUANCE OF A BUILDING PERMIT
VARIANCE(S) LISTED IN "REMARKS"
MIAM! SHORES BUILDING AND ZONING
UNLESS SPECIFICALLY LISTED BELOW.
\ D COUNTY LAWS MUST BE COMPLIED
.41Ino i e 1 Strilture Date
• WITH NO VARIANCES • WITH
NO OTHER DEVIATIO'?S FWJM THE
ORDINANCES WILL BE PE ° ;.41TTED
ALL OTHER APKIC \B'E ".TATE
WITH BY ALL PARTIES.
FIRE DEPAR;: E il'
............
1 IC WO1? S
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PO' L'E DE:'',:a E,;;
BUILDING DIRECTOR
PLANING & ZJ i. ;G ;;u •.:.,
VILLAGE COUNCI'.
APPROVAL
PRELIMINARY: (Mau
REMARKS:
COMPLIANCE WITH THE SOUTH FLORIDA BUILDING CODE AS ADOPTED
BY MIAMI SHORES VILLAGE IS REQUIRED. THE ARCHITECT, BUILDER &
SUB CONTRACTORS ARE CHARGED WITH Tut- KNOWLEDGE OF ALL BUILD-
ING REGULATIONS WHETHER OR NOT SPECIFICALLY INDICATED HEREIN.
1 �
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 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 copy of approved
plans and specifications must be kept at building during progress of the work. .S 13 i e „ � � / � Date yye�h( ,p-
� ,fig (v U
Owner's Name and Address.. � / � C'/ No /1 l
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block
Street and Number where work is to be done
State work to be done and purpose of building (by floors)...
Subdivision j
New Building Remodeling Addition Reprairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ G ;,. 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 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 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 ie k to be rformed under this
permit, as are licensed by Miami Shores Village.
'Z.C:
Remarks (Signed)
Permit No
Disapproved
(Signed)
L
fi
yt
Building Inspector
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L. 7
Street.
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and for no other purpose.
STATE OF FLORIDA, I
COUNTY OF DADE. ss
Before me, the undersigned authority, a notary public, duly authorized to administer oath:: 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.
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
` Read, Sworn to and Subscribed before me.
‘ I 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 $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 $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
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