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MECHANICALOwner's Name and Address.. 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. A copy of approved plans and specifications must be kept at building during progress of the work. Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: Lot Block Subdivision. be sent to STATE OF FLORIDA, COUNTY OF DADE. j Permit No.._. _ Disapproved �/f (Signed) 4 ss. Date e Building I +ector Dat Street and Number where work is to be done =� State work to be done and purpose of building (by floors) ..._. /, 19 and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Cowing 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 the plans a • d s p . ications for said buildin . 11 notices with ref rence to the building# and its construction may I hereb y subm' ( g ' 0.. 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, 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 in ection on the site • the work such e, blic notice or notices as are required by the Act. The undersigned agrees to employ only such sub ntract+ s, on wor j o pe - junder this permit, as are licensed by Miami Shores Village. r Remarks (Signed). 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. Read, Sworn to and Subscribed before me. 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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date // N- 9 i Job Address /03 5 3 / g. g5 S7 Tax Folio Legal Description Historically Designated: Yes No / Tenant /4 .L lmi¢A/ Master Permit # Owner's Address J 2',f / 4 a c�5 Phone 2579 -- SD - T:2 7 Contracting Co. G. S1 f Address /� ©© , � /67 /v. /17 /, ce Qualifier e X1'4 State # Architect/Engineer Bonding Company Mortgagor Permit Type (circle one): BUILDING ELECTRICAL PLUMBING WORK DESCRIPTION -- 1— �.!'sS7.¢L 1 ,44'4( am OWNER'S AFFIDAVIT: I certify that all the foregoing information is ace 1: . egulating construction and zoning. Furthermore, I authorize the ab or C ary as to Q Ter an ' it Condo President Co tsr• i r ado President Date • t M FEES: PERMIT 17- RADON APPROVED: Zoning Mechanical Municipal # 11 KENNETH SHEHMAN NOTARY PUBLIC, STATE OF FLORIDA My Co emission Expires May 24, 1999 Commission # CC 467719 9s - • Competency # Address Address Address Square Ft. Estimated Cost (value) ; No : as to Contractor or Own My Commission Expires: C.C.F. NOTARY Phone Ins. Co. . ROOFING PAVING FENCE SIGN 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. t all 'ork.;will be done in compliance with all applicable to ©\the work stated. ROBERT N. WATSON, JR. NOTARY PUBLIC, STATE OF FLORIDA *Commission Expires Sept.12,1999 Commission # CO 494920 TOTAL DUE yi Date Date Building Electrical / // 7 /9....r Plumbing Engineering