510 NE 95 St (9)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address S ( 0 /U E Cr S . ( Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant \.J / ft-1 Lo" Master Permit # / .5 7 3
Owner's Address C -1 D Of q - _CT Phone
Contracting Co. c:; --I C'/1 , Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 1(l ,2(O CUc - - - 16r i G 1( p 0&_/,s
Square Ft. (0 0 S • • Estimated Cost (value) 110O 0
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.
FEES: PERMIT
Signaturd' of own?' or Condo Pre ' • ent Dat- Signature of Contractor or Owner- Builder Date
Notary as to Owner andlor Condo President
My Commission Expires: .... ,
RADON
Date
APPROVED: /_
Zoning Building '' / 1 l7
Notary as to Contractor or Owner - Builder Date
My Commission Expires:
C.C.F. '4f NOTARY BOND
TOTAL DUE 4 16 7
Electrical
Mechanical Plumbing Engineering
5 .12 N.W. 7TH STREET, SUITE 202
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11. 'WI, FLORIDA 33128
....' EPH. (305) 220-3171
F: (305) 554-7822
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PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
10050 N.E. 2nd Avenue • Miami Shores, Florida 33138 • Phone: 305 - 795 -2204 • Fax: 305- 756 -8972
DateCk.r -off Job Address 510 5 Tax Folio
Legal Description V 53 4). Yv, - S►-.-S Sc t Z Historically Designated: Yes No
j i o-- 3) t 5 10 5 11 my, S5 WT
r /Lessee/Tenet TOvv0vS c TNW,(cA., Peoltc6I Master Permit # -i '? 2Z3 _ctu
Owner's Address 5) 0 N.z . °e S Phone
Contracting Co. C.. E L / — .maze)", Wv,ST4U61;....— Address S9 CYS S(.,1- ..IW 14 -
Qualifier (..DI,W7 , i (') 5 . J0 ' Y ih SS# Phone �S " LIO% IcAS 0
State # ((SG C' LQ Z. S `) N Municipal # Competency # Ins. Co.
IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY,
THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE
BEFORE CALLING FOR ANOTHER INSPECTION.
Permit Type (circle one):
WORK DESCRIPTION: L N1JIl w
Square Ft. Estimated Cost (value) 11A1 Z:(40(11
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 ANY 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). 1 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 all disciplines.
OWNERS 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 contract to do the work stated.
ure of owner and/or Condo President
‘1,
Notary as to Owner an
My Commission Expir
T (d0
A ( g
� ,\EI<OV D: /),— /(07-
Zbn n b
Mechanical
ls�
ELECTRICAL PLUMBING MECHANICAL ROOFING
6 -10
Date
Signa Te .Q►'Contractor or Owner Builder
• c' 1 ° h ONA E ATEN
/ MY COMMISSION N CC 883629 �
FEES: PERMIT 4 °10' orit ' :.�r.:Tmg• t4 J:� OTARY
1.8003•NOTARY rw. Notay Service Bonding Co.
4 7 j 0 0 6-11.03-4 Y(47 T
(
Date
Notary as to Contractor or owner Builder �� 4 .20 Date
My Commission Expires
4 ,0, 4 „ ef.
ONA E ATEN
mYffiff CC 883629
• OF ^ EX? : an l',
1-800-3-NOT • F
Building Electrical
Plumbing Structural Engineer
PERMIT NO.
ADDRESS:
MIAMI SHORES VILLAGE
BUILDING / ZONING DEPARTMEN
SECTION
BY
DATE
ZONING'
ELECTRICAL
MECHANICAL
PLUMBING
FIRE
- PUBLIC WORKS
STRUCTURAL
BUILDING OFFICIAL
1. Subject to compliance with all Federal, St:
Co.z ty.W age rules tr:d regulations. Yi((age muff
no responsibility for accuracy oflor results (t
these plans.
2. This copy of plans must be available
b ding site or no Inspection will be condvd
JOB ADDRESS
APPLICANT
PHONE #
APPUCATION
DATE
1
(4)Pw(Luv'\
CRITIQUE SHEET
SHEET . OF
MISCELLANEOUS
ZONING
COMMENTS
(( / . I`1U ( !Ave O - 51 �� DN yQ cce
"�eoe?e'7")'' �/f . 7/t
S cr . GG r T
INITIALS