702 NE 95 St (2)APPLICATION FOR BUILDING PERMIT
Application is hereby wade 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 budding during progress of the work.
1-17 7
Owner's Name and Address Pr 5 • L D `'°" (2 " 1 — No , Street.. N'
.
Registered Architect and /or Engineer . . ••.•__.,_ *_,_., - ..
' r . !�
Name and address of licensed contr,�ctot.�... c� 31
Location and legal description of lot to be built on:
Lot Block Subdivision
•�- t
Street and Number where work is to be done 7e5 S /4'
State work to be done and purpose of building (by floors) Nz
Disapproved
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
?,e,ee 7 Oa 77.x. Y�./ J
Notary Public, State of Florida
My Commission Expires
ode- <i ft_ 'tA .1
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of pundatti n Roof Covering
Estimated Total cost of improvements $ ' ner:' Amount of Permit S.
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 i,- pection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such s • • tractors, on orb -to be performed under this
pennit, as are licensed by Miami Shores Village.
�
Remarks ( Signed ).._ 1. F c.
STATE OF FLORIDA, `
COUNTY OF DADE. j 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 stated are _ f
Permit No.._ 452_ - Date / / 0 7- Read, Sworn to and Subscribed before me.
PLANNINC 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 fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /`r workmanship.
' d (
IT APPLICATION FOR MIAMI SHORES VILLAGE
dress -70,7--- N &` 91 Tax Folio 1/ 2 z M /y M3os
J , 3 7 'Il'l gio,// 3
- ° \ CA ) Master Permit , 3 a U i
` AA ll �� S4- p
/ ■v Phone 7 5 f` 1 0 4 1
6
1
Address
SS# - - Phone
_apal # 1 Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION VAcr ,6 yr °e.L /V
Square Ft. Estimated Cost(value) / , ®'P12
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 of owner and /or Condo President
Date:
•
of Contractor or Owner -Bu
lot
on
der
1,;;; JOSEPHINE CHURCH
:Notary Public. State of Flon&i
Signatur
Date: /4J
in nt type or sta r� sy . No .
Notary as to Owner and /or Condo President Personally now ' II � I
My Commission Expires: Type and nur eh � $ . Sci tg O1.
DID take an oath, or
** * * * * * * * IS DID NOT *take an Daub.
APPROVED: Fire
Zoning
Mechanical
FEES: PERMIT r 3 7C RADON C.C.F. 1 J`' e NOTARY J TOTAL DUE 3/4f4
Other
1f lectrical
Plumbing Engineering
**