800 NE 95 StDate l 5 KJob Address
Legal Description `
Owner/Lessee / Tenant M C `-
Owner's Address /•-I t ( "' - ‘ 1 ""/ Sep
ignature
of
My
PERMIT .APPLICATION FOR MIAMI SHORES VILLAGE
E 1-15' Tax Folio
Contracting Co.
Qualifier ;
State # C7 \ Cz •-( Municipal #
Architect/Engineer
owner and/or Condo President Date
I,CtARifet@lrt
i i1 ((�� I pi
SSiOn Cp1Sp�� VIONTIEL
2 ( �� COp�IIYISSlON MOUSIER
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OFFS ..
1'EES: PERMIT - RADON
Address �S - \ � F C- "\r
Competency #
Address
Address
Address
Bonding Company
Mortgagor
Permit Type (circle one): BUILDING ELECTRICAL PLUMBIN G MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION S . - a
vs? \/C
Square Ft. c Estimated Cost (value) - 1 `' t
I 1
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 accura at all work will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above - arced c..n actor to do the work stated.
Kg-
Date
s
C.C.F. /-
0 �
APPROVED:
Zoning Building
Mechani
e --'4-/
Plumbing
Historically Designated: Yes pT
Master Permit # 0 02 O (,/
Phone
\* Phone V \
Ins. Co.
S `•,/ ga -� c2n
Contractor or Owner- Builder Date
Notary as to Contractor or Owner - Builder
M i o tspc°'�n` i NOTARY say ., FbL
2 ., - , " SANDRA Ili MONTIEL
)' xr COMMISSION NUMBER
I
F cz, PAY COMMISSION EXP.
Sri F.o b 1.3 G 7 1998
NOTARY S: TOTAL DUE
Electrical
No
Date
Engineering
BUILDING INSPECTi*ONIDEPARTMENT
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 building during progress of the work.
�o J • /� ,3
R Date.. ,19 .
Owner's Name and Address a. .. :T_. ...../�1.i�... (. .f...d ..�. No. .. .......». Street_._. - -. ww
Registered Architect and /or Engineer ---^
Name and address of licensed contractor 1.0 Li. N... ....�f.1 t�.lv :
Location and legal description of lot to be built on:
Lot 1 Block Subdivision j D...^..t
Street and Number where work is to be done f°
♦
State work to be done and purpose of buiJ ing (by floors)..... .Le2 5: ✓ . f.. — / 1 ° a. 7, _ _ /- a .1..11 4 _._
New Building Remodeling Addition Repairs
MIAMI SHOR S(VILLAGE
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ ° •
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 ssbFo tors, on •'k to 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 ap-
peared
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 tru
,¢
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re-inspection fce of $1.00 will be charged
materials and /or workmanship.
Permit No.._ T Date
Disapproved _......___.__ Date._ _...._...__.. ...
(Signed) ..- L i J W !
Build, .Inspector
Chairman
Mcrnbcr
Member ......
Council Approved Date
and for no other purpose.
No. of Stories
ead, Sworn to and Subscribed before me.
Notary Public, State of Florida
PLANNd'C BOARD DATE
ommission Expires
to me well known,
Member
Member
Member
Disapproved Date
making corrections or changes to this application after approval has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty