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739 NE 94 St (9)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 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. State work to be done and purpose of building (by floors). state exterior colors (submit samples) Date a l/ � 1910 Owner's Name and Address file ' ,44,2/ � ` <</ T 7 *sir Street Registered Architect and/or Engineer G(/A re. oe A,. d A c Name and address of licensed contractor Witc.Tet- 7)04.40‘) 4 A a / S T o2 35 6'61 Location and legal description of lot to be bui on: Lot cf JJ' 049 Block 1 7 Subdivision 7)/ g,' la? 1 / f ©� / q (Zoe 1 Street and Number where work is to be done 73 9 /477 95 5 r �j�Tfe �o �i4 i^/ r 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 � L L Amount of Permit 6 5 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 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 obligatons 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 sum tractors. on work to be performed under this permit. as are licensed by Miami Shores Village. Remarks i ' . STATE OF FLORIDA COUNTY OF DADE. } ss• Before me. the undersigned authority. a notary public. duly authorized to administer oaths and take acknowledgments. personally appeared 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 true. r • p Permit No. © 'S l Date ""' -1,0 Read. Sworn to and Subscribed before me. Disapproved (Signed) Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of 825.00 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 625.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials anchor workmanship. Date Notary Public. State of Florida Date l 8 Job Address PERMIT APPLICATION FOR MIAMI SHORES VILLAGE X39 /t/g: 94 Tax Folio 11 :32Olp Z000 f5 Legal Description T t/ �8' '.1 b!L Pi • Sso 2 Owner / Lessee / Tenant ys' /% 0F7,1/c/7 Master Permit # 7 3 9 4/'/5 � 9 9 Contracting Co. e -®/0� 1C00 • C /c&_ -°. Address Qualifier leggAvce G Phone fV7 -166 7i Owner's Address State # Municipal # D23 /,/23 Competency # //31 Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION 0.04,L Curt d V .C.� tv- -4 ' V Square Ft. Estimated Cost(value) 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. ' 4,47m4/k/t ignature of owner and /or Condo President Date: 3 l $t./ Notary to Owner and/or Condo Pr i Not y / dent My Commission Expires: NOTARY PUBLIC STATE OF FLORIDA MY COMMISSION EXP SEPT.20,1994 BONDED THRU GENERAL INS. UND. FEES: PERMIT ,11•46 RADON APPROVED: Zoning Building Mechanical Plumbing C.C.F. )* NOTARY TOTAL DUE �1 Fire Other Signature of Contractor or er- Builder Date: 3 19 -Qf Notary as My Commis Phone to Contractor or • - Builder sion Expipl: PUBLIC ST TE OF FLORIDA MY COMMISSION EXP SEPT.20,1994 @AiVA €� THRU GENERAL INS. UND. * * * * * * ** Electrical Engineering