460 NE 95 St (10)t ?3- -4-177
-�, �MJAMI SHORES VILLAGE
•
BUILDING INSPECTION DEPARTMENT =
rit APPLICATION FOR BUILDING PERMIT
Application is hereby uindc for the approval of the detailed statement ur rile plans and specifications herewith submitted for the build
ing or other structure Iwrein 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 prggreu of the work.
Owner's Name and Address
Registered Architect and /or Engineer............ ,,.,. . ,... .,,,.,, TIT .,........„. „, „, :,,.
Name and address of licensed contractor /--f 1 V
Location and legal description of lot to bc built on:
Lot Block / Subdivision
t
Street and Number where work is to be done 7 G 0 N e
State work to be done and purpos o bur ing (by floors) --T'/`r 5 TA A �J�C- uN/ i
.._Z6._ —... ,19.. --.—... _
E / �- c, — No.... �° O _....... Street._... Z _� 1 -rs4.
_........... for no other purpose.
Ncw Building Remodeling Addition Repairs No. of Stories _
To be constructed of Kind oLfoundation Roof Covering
Estimate Total cost of improvements $ /r O O
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 htbur 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 - contractor employed by him
in the work to bc performed under this permit; and will post or cause to be posted for inspects of the wor such public otice
or notices as arc required by the Act. The undersigned agrees to employ only such subco actors, on wor to'be pttrformed- is
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 slat ar e.
Permit No.._...._...... _ Date a ” �) Read, Sworn to and Subscribed before me.
Disapproved . %. \..._�.. Date Notary Public, State of Florida
/3ui ding Inspector My Commission Expires
PLANNING BOARD DATE
C Member
MIcrr,ber 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.in.pec•tion fee of 31.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
l 0 Job Address
Date
Legal Description
/ / Lessee / Tenant
Owner's Address
Contracting Co. C4R A:( CAL C , Address "2-0.4 /1.1b,... /3iii o
QualifierPOG -1 f f \,S7` / Phone L/
State # # Competency # Ins.Co. er✓> .
Architect /Engineer
Bonding Company
Mortgagor
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
` 4C( 00711(6-e-4,04-1= /4 , / . f 4 - C.VI . YeA S(R
Q>L� -) 41 .- u t ( f o ,CC. c,Q f u. -t firrr
Estimated Cost(value) 1 p clad AD
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 structiop and zoning. Furthermore, I
authorize the above -named contractor to do the work stat
C /
/
Signature 7 ` o e
Date: �`' e MEW
'z � A MY COMMISSION # CC438959 EXPIRES
February 14, 1999
BONDED TNR"; WMY FAN NSUAANCL, U C.
Condo President
Notary as to Owner and /or Condo President
My Commission Expires: a_1u_
APPROVED:
Zonin
Mechanical q
6 OM U
e F 6 9 Rt
r cJ'i 6 11.4 Cco L,I4> j Master Permit IF ?S y 7
1 -6;(3 p c 55 �� Phone �S$ -�3 /S
** * • * * * * * *
FEES: PERMIT RADON C.C.F.
Tax Folio
Address
Address
Address
Signature "bf Co tractor or
Dater °'::: PAnaAIUM
MY COMMISSION „CC438959IXP1
February 14, 1999
Notary as to Contractor or
My Commission Expires:
* * *
Fire
Building
Plumbing
�Gc�F vt )`
Owner-Builder
4 /^
/ o
Owner -Bui
* * * **
NOTARY TOTAL DUE
Other
Electrical
Engineering