PAINT PERMITSr nm 1 i - "Ar rritdm 1 O FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
1 l0 0 E cA2-k cc)-'
Job Address
Legal Description
/ Lessee / Tenant
Owner's Address
Contracting Co.
Qualifier
State #
Architect /Engineer
Bonding Company
Mortgagor
PERMIT FEE:
en _r 156
r eel)
Zoning
Tax Folio // 3„20.r e/740
Master Permit #
phone
Address
SS# - - phone
Competency # Ins. Co.
Address
Address
Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION QQ_Q (2,- r 0&)--kS 2Q- 1 )-.c - 0,.„
Square Ft. Estimated Cost e kS)00-UD
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. 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.
or Condo President Signature of Contractor or Owner- Builder
ate:
C €C'CCL A- 6119-/
otary as to Owner and /or Condo President 'f`lotary as to Contractor or Owner - Builder
My Commission Expires: NOTARY PUBLIC STATE OF FLORIDA My Commission Expires:
* *MY COMh !;SION EXF tlES 5/09/ t * * * * * *
APPROVED.nded thru Stemblsr-; ? Rf Other
Building a---)21tmisi
Electrical
Mechanical Plumbing Engineering
Owner's Name and Address
•
Registered Architect and/or Engineer
Name and address of licensed contractor a L44
Location and legal description pf_lot to be built on:
Lot U /6 Block I Subdivision 2)
Street and Number where work is to be done
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
'PLICATION FOR BUILDING PERMIT
n proval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein
i rpliance and conformity with the Building Ordinance of Miami Shores Village. Florida, and all provisions of the Laws of the
n chores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether
c d plans and specifications must be kept at building during progress of the work.
`74
Date __37t)2 S 19 (�
No. / Street /( '/ — 9 S �
ilea) // I P Or ,e
State work to be done and purpose of buildi : (by floors), state exterior colors submit samples) ' n/ � .
(tn_ O P stet)) Z I In+ 6lAz_ and for no other purpose.
New Building Remodeling
Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
c..
Estimated Total cost of improvements $ *-
Zone cubage required Plan Cubage
Amount of Permit
Distance to next nearest building Size of Building Lot
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
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 : quire similar
compliance from all contractors or sub - contractors employed by him in the work to be performed .er thi .ermit: and will post or cause to be post:: for inspection
on the site of the work such public notice or notices as are required by the Act. The undersig. •d agrees to mploy only ch ..contractors. on wor /o 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 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.
Permit No
Disapproved
(Signed)
9 �♦
Date
Date
Read. Sworn to and Subscribed before me.
7
Notary Public, State of Florida
Building Inspector 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 workmanship.