515 NE 95 St (3)Chairman
STATE OF FLORIDA,
COUNTY OF DADE.
Permit No._
Disapproved — ____—
(Signed)
of the above described construction, that he has
therein by bim / stated a true.
Member
Member
Council Approved
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 regula-
tions 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.
+ I _ Date________ ___A, 19_____
Owner's Name and Address _ . _ f 1e� (4- ' No \ Street
Registered Architect and /or Engineer_—___ i -
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot___ _____________ Block___ __________ Subdivision ,, II
Street and Number where work is to be done N
(5 ,, E .
State work to be done and purpose of building (by floors) QQ r7 _l . Cr c _____ 4' _l__ C ----- _ - - _and for no other purpose.
New Building Remodeling______ —__ Addition — _________ Repairs No. of Stories
To be constructed of_— ________________ Kind of foundation Roof Covering_— ____ _____ __________
Estimated Total cost of improvements S� — �S2_ _____,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 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 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 inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed) dM ( i --
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
and who, being by me first duly sworn, upon oath deposes and says that he is the
fut, read the f9egoing application, and that he did sign the same, and that all facts
_ Date
__ Date
Read, Sworn to and Subscribed before me.
Building Inspector My Commission Expires
PLANNING BOARD DATE
Member
Member
Notary Public, State of Florida
to me well known,
Member
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 $ 1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
Date
PERMIT APPLICATION FOR MIAMI SHORES VI
Job Address 5 �� •‘ 1 S � ST^ Tax Folio
-.32.0 — 0/
Legal Descriptions C- arAY f L & / . 27/( - Historically Designated: Yes
Owner/Lessee / Tenant M..e lima- FO Y? . 4 T Master Permit # _
Owner's Address 1 J i) £ ? S �T Phone , , Q
Contracting Co. 0 L "[EA-- 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 P G w y. A ✓ W ES 1 4 . 1
4s 0 - 1 rt M. rt I swrr SLerars •
Square Ft. Estimated Cost (value) \J0 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.
Signature .f , iwner and/or Condo President
f
. /Notary as
My Commission Expires:
and/or Cond resident Date
FEES:. PERMIT IC:). 0 cv RADON
OFFICIAL NOTARY SEAL
TANIA C FERREIRO- AGUTAR
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC334227
MY COMMISSION EXP. DEC. 6,1997
gi9
D to Signature of Contractor or Owner- Builder Date
90
Notary as to Contractor or Owner- Builder Date
My Commission Expires:
C.C.F. . So NOTARY
APPROVED: D�
Zoning Building °l91° Electrical
Mechanical Plumbing Engineering 4°.)
TOTAL DUE '(0. cf0