510 NE 95 St (8)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 building 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.
�-. (v � 7
1
Owner's Name and Address 1 Q/L� "� �SON 4Q i 1/4S70 Art- �S J� No. Street
Registered Architect and /or Engineer
(/Name and address of licensed contractor
Location and legal description of lot to be built on: ,Q
Lot /a Y J / Block Subdivisions
�reet and Number where work is to be done JL 0 i ,q��
ate work to be done and purpose of building (by floors), state exterior colors (submit samples) / /i�rr ��1� ,►'v'9
F — ( 4i ?r
and for no other purpose.
New Building Remodeling Addition Repairs No of Stories
To be constructed of Kind of foundation Roof Covering
mated Total cost of improvements $ ite ''BZ' ,5j Amount of Permit S v 2, So
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 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, a - 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 der t is permit: and will post or cause to be postedlor inspection
on the site of the work such public notice or notices as are required by the Act. The undersigned grees . employ only such subcontractors. on .. t t 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.
9 a /
Permit No. UC J "I Date ' Read. Sworn to and Subscribed before me.
Disapproved
1
(Signed)
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Hate 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 andior workmanship.
Date
19Te G /90 '3o
19�
Notary Public, State of Florida
PERMIT APPLICATION FOR MIAMI SHORES
Date /((?/q D Job Address S( 0 7 r ( Tax Folio
Legal Description Historically Designated: Yes
/ Tenant NJ Id-1 Lo of F Master Permit #�
r' Ionic Green
Owner's Address
■ �(0 (� � Phone � S 70YY 65/090
Contracting Co. (9 ■A_J i E Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Address
Architect/Engineer
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION fCiC -, X (a r goo v‘-//-4/7E.._ f c) v« H«,E
R..1 o EAU r< S , i 00R WigrT ^ccoS 5744_/ g - Isrrv
Square Ft Estimated Cost (value) (
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.
Signatures er and/o ' ondo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT
(
a ature o or or Owner -Buil
i•
tor or 0
Si
Notary as to Contra
Wifitt NOTARY SEAL
e e l SANDRA M MONTIEL
* COMMISSION NUMBER
• CC4012
Q MY COMMISSION EXP.
11' OF 0. AUG, i7 998
My
RADON C.C.F. v 6a NOTARY
BOND
Date
TOTAL DUE `S'
Monsoon
110G�9B
. 3�1
Date
APPROVED:
Zoning Building ' 1 I ! Electrical
Mechanical Plumbing Engineering
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building / f
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
MIAMI SHORES VILLAGE. FLORIDA
PERMIT N° 4340
CONTRACTOR OR BUILDER
Work to be performed under this Permit
Subdi-
Bl vision
Value of
Project $ ' a
DATF
Contractor's
License No.
Amount of
Permit $
1 )
f z 1
�r
195
This permit is granted to the contractor or builder named above to construc the building or to install the equipment or device described in the application
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 responsibility for work
done by his agents, servants or employees. ,r
Signed. 1 a B ,
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY e ,,