805 NE 95 StAPPLICATION FOR BLJILDING PERMIT
Application is hereby made for the approval of the det, iled statemen of the plans and specifications herewith submitted for the build-
ing or o h. :ructure her r described This i is made in compliance and con•o'm ty w.th the Building Ordinance of Mia ti
Shores Village, or da, and all pro isions of the Laws of the Statc of Fh.rid. all o d nances _ Mi m Shores Village- and all rules and
regu a of the Building Div.. i of .lam Sho. illage 1- '1 ,e -o, ipl.ed with, whet] er in specified or not. A copy of approved
plans and specificati •ri must be kei at building durin progress of tl.e work.
I
/,
Owner' Name and Addres j 1 17____�
Registered Architect and /or Engineer._. 1.__ __..___...._ _ r_ _
Name .rid address of licensed contractor
Location and legal description of lot to be built on:
Lot __ Block._
Street and Number where work is to be done_
State work to be done and purpose of building (by floors) E'
The unde signed appli ant for th s building permit does hereby certify tat he understands
of 1• bor under he Florida Workmen's Compensation Act being S. -tion 5966 Coi p led Gen
and h s compl ed w.th .he prov ions thereof, and will require s•milar coin}: lance from all c
in the wo'k to be p rf -med under th s pern it and ill post or cause to be posted for insp
or •otices as are requir d by the Act. The u. d.r ign -d agrees to employ only such ubc
permit as are licensed by M am, Shores \ il': ge.
Remarks_ ( Signed
Permit No..__
DisapproN
(Sign; d)
L
MIAMI SHORES VILLAGE
BUILDIN INSPECTION DEPARTMEN
ng Inspector
�
Date_.
Date__
Subdivisioi1
Date
Addition......__ ___ _____ __ _ Repairs_ _ _
No. of Stories.
Roof v' ring__ _.
Read, Sworn to and Subscribed before me.
Notary Public State of Florida
My Com:nission Expires.
and for no other purpose.
New Building_ _ _ Remodeling__
To be constructed of_ _ _ Kind of fo ation
Estimated " :tal cost of improvements $__ !. Amount of Permit $
Zone -ubage required. __. ___ ___ flan Cubage_____
Distance to next nearest building__ _ _ _ __Size of Building Lot
Maximum live load to be borne by each floor
hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
and accepts his ,.bligations as an employer
Laws of Florida P r anon. Sipple Went,
or sub -con tors eniplo 'ed by him
e site o e work su hi public note e
to be perform d . der this
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to adm :nister oaths ...nd take acknowledgments, personally p-
peared _
.to me well known,
and who, being by me first d. ly sworn, upon oath depo and says that he is the
of th abov de .e ib:: istruction t. h has carefully read the foregoing application, and that he did sign the sane, and that all facts
therein by hi tate e tr re.
PLANNING BOARD DATE
Chaim. an __ % 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 tft'-r approval h is been obtained from
the Plamr ng Board
A re- inspection fee of $1.00 will be charged when such re- inspection is ma :le necessary by improper notice for inspertw or fa. Ity
materials and/or workmanship.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 1`.3 14 1 Job Address A/ VO W E . SS Tax Folio
Legal Description \\ V2 -1-S
N.a hM t S . .3
Owner/Lessee / Tenant 1/ 2.0 J A.
Owner's Address ! t O eat. c ,
Contracting Co O (,
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Address
w/A
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one: BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE
/Ye q—
t(
WORK DESCRIPTION h.
Square Ft. Estimated Cost (value)
3 SO
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF CO
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF
OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF C
Application is hereby made to obtain a permit to do work and installation as in
will be performed to meet the standards of all laws regulating construction in
PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNERS AFFIDAVIT: I certify that all the foregoing information is acc
construction and zoning. Furthermore, I authorize the above -named contrac
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Conunission Expires:
FEES: PERMIT O RADON
Historically Designated: Yes No
Master Permit #
4 20y Phone (S) 'S4 2 yZ6 V
080 ? 2.«y `fr JJ
Address
Z
APPROVED:
Zoning
Mechanical Plumbing
Address
- "SZ ok - o\y
NCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR
OU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER
NCEMENT.)
No
M
C.C.F. '° v " NOTARY
bove, and on the attached addendum (if applicable). I certify that all work
•sdi lion. I un rstand that separate permits are required for ELECTRICAL
n .ctor or
be Q4ne in compliance with all applicable laws regulating
Structural Engineer
er- Builder
SIGN
BOND
TOTAL DUE c '
l A./; 7 70(
as to Contractor or Owner- udder a te
ConunissionExpres: . Po Ann Cooper
� ,: 1 ISCommission # CC 745383
'. �, lxprea July i,2002
BONDEDTHRU
ATLANTIC BONDING CO.. INC.
7
7/)/ 6 /
Building / 2L3k Electrical
DATE:A 30— 6 -- Ze) 0 \
OWNER'S NAME: ,rte ? PHONE:0$6 Z2s,`i -/ (t 5
ADDRESS eg OS 6 - - ?-S Oa_ 4 1 I
** ****at** ***** **hex?C $ C************ ** * ** ** **k ****** *** *** ****
ADDRESS OF SITE: SOS mil€ . 4 5 (5---
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
W a l l s p L L\ a2 a I\ LIS `7 7 1172 s,G
Fascia \
Drip Cap/Drip Edge
Soffit t,•J'\ ■
Roof
Flower Bins
Shutters v,iNf‘X
Awnings Lighthouse Pointe
Chimney pc'- /S .)-e3V Z-5; 6 45YY 79/256
Doors and door jams k
Garage Doors D<
Railings
Fences
Decorative Metal
All brick (simulated or regular
Stucco Banding
Any other stucco features
Accessory Buildings
Ot -r
S AFFIDAVIT: I certify that all the foregoing information is accurate
an :11 w.rk will be done in compliance with all applicable laws regulating
co - ion :,nd z•i ing. I authorize the above -named contractor, if applicable, to
do i1 . s ar- , hermore , the paint colors will be as per the attached
‘4 I
. Contractor
Date
Signature of Owner Date Signature of Contra
*********************************** * * * * * * * * * * * * * * * * * * * ** * * * * * * * * **
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
APPROVED:
7h4
Building Off � al Date
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
c)
0
4/23/01