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Date `fligy Job Address /17 fVG 4 , 4 �
Legal Description
Owner / Lessee / Tenant ,A '-� �- ZIEPAY C A�wT
Owner's Address N7irc 9.,
Contracting Co. OW1/4/E2 - ilAsE4.
Qualifier A/ /A
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING ENCE SIGN
WORK DESCRIPTION ( 12 Ea-o'./1r3Pa v 6�JAY
C2..EP1. •JG1 1 w 1 TH C-O,J G - 1 2 - e , T •
Square Ft.
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.
✓ t /
Signature of own r and /or Condo President Signature of Contractor or Owner- Builder
Date: (!/(( /S / C Date:
Notary as to Owner and /or Condo President
My Commission Expires:
„ P(i OFFICIAL NOTARY SEAL
� SCOTT W DAVIS
;'q ;• o COMMISSION
* 5g37 sE
� F & MY COMMISSION EXP.
OF,P..o . >,,a 1997
Zoning
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Q V x 1(4)
FEES: PERMIT Y/
1 0
APPROVED: Fire
SS# - -
Buildin
Address
Tax Folio 1 1 a2-1510(p 13 21130 too
Leer E w 1/2_ I `i
Master Permit # S6030
P h o n e ( ' ) - 7 r't - L o y y
Phone
Estimated Cost(value) 2:1 0 53c
Notary as to Contractor or Owner- Builder
My Commission Expires:
* * * * * * **
NOTARY (- 47 V TOTAL DUE 1
Other
Electrical
Mechanical Plumbing Engineering
Owt Ws Name and Address V‘-5
Regidered Architect and/or Engineer
Location and legal description of lot to be built on:
.......... ......
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approyal of the detailed statement of the plans and specifications herewith submitted for thelmild-
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 building during progress of the work.
Date_
7- 2-6 , 142'
Date
No. I/7 Street `
Name and address of licensed contractor_ , •
Lot Block Subdivision
Street and Number where work is to be done %(7
State work to be done and purpose of building (by floors)
:":" CA7 . 4 7 :1 14 'c -,-- "<";"2 •
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 $ 1 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 foi said building. All notices with reference to the building and its construction may
be sent to__ _
The undersigned applicant for this building permit dot 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, Pennanent 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, n work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks__ _ (Signed)
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 Y 7 7 9 Date., — — 7 Read, Sworn to and Subscribed before me.
Disapproved
( Signed ) el- .e._, .._(--._ . __ Notary Public, State of Florida
Building ector My Commission Expires.
PLANNING BOARD DATE
Charman Member
Member ...... Member
Member Member
Council Approved _Date Disapproved
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.
Date
A ,9,r5 -/
BUILDING ❑ MIAMI SHORES VILLAGE, FLORIDA
ELECTRICAL ❑
PLUMBING ❑ PERMIT N°
OFING ❑
a-rtr,
Work to be performed under this Permit
1
Owner of
Building
Architect
Contractor e ) 1
or Builder's" 'f'»., 44 'T- - ye is
Legal Lat 1
Description BI
Address of J '6,04' -4
Buildin / ti ,S f
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 applica-
tion 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 ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
Signed • +� Z — # ( ' CAC INSPECTOR) BY
In consideration of the issuance to me of this permit I ree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, dr ings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all wor "done by either, myself, my agent, servant or employee.
CONTRACTOR or BUILDER
Date r! °` ' 1947
8979 Contractor's : U
License No.
BY AUTHORITY
Subdi-
vision
Sq Ft _r`l
Value of I I Amount of ..r►
Project $ 2 0 fi Permit $ '�'`