PAINT• 0f / - W
•
Application is hereby made 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.
Owner's Name and Address � f� �____
Registered Architect and /or Engineer
Name and address of licensed contractor - - - ��
Location and legal description of lot to be built on:
MIAMI SHORES VILLAGE - /,,, '®
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date
Buildin
Lot Block Subdivision_
Street and Number where work is to be done ®
.State work to be done and purpose of building ((by floors)
Date - ' • 1(
No.__j_� � tr Street
;,,/
19 r
4 - - - - --
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation_ _� pot
Estimated Total cost of improvements $ 7 ® 9 Amount of Permit $_
0
Zone cubage required ____flan 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. �J
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 .
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above des ibed construction, that he has caref y read the foregoing application, and that he did sign the same, and that all facts
therein by him ted Vie.
Permit No (i.t Date ` ' "� Read, Sworn to and Subscribed before me.
Disapproved
(Signed)
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman / Member
Member Member
Mernb'er 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- 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. -
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Contractor
or Builder
Legal
Description
Address of
Building
(�
Lot
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N? 6195
Work to be performed under this Permit ;) `
i
..-�/ % - ! / '' / y( ,f9 l i.- 4'cr ,
v�' ii
Architect
Bl.
sibility for work done by his agents, servants or employees.
CONTRACTOR OR BUILDER
(
A
+r-
Signed.
Subdi-
vision
Value
Project
BY
DATE
Contractois
License No. =�f
Amt. of. '
Permit
l
CM-
This permit is granted to the contractor or builder named above to construct the ." ding or to install the equipment or device described in the appli-
on herefor in strict compliance with all ordinances pertaining thereto and with the u a derstanding that the work will be performed in compliance with any
b ans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
„13,'4t any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
'' eniiiit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge,of the ordinances and
rregulations pertaining to the work covered hereby whether shown on the plans or°dra gs or in a tafements or specifications and'that 443 respon-
24. INSPECT By ~
194
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations .
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper autho&ftfitE of Miami Sh4eslhl)Age.
In accepting this permit I assume responsibility for a work done by either myself, my agent, servant or employee.
AUTHORITY
Date- c t c Job Address 'r & 1'J E -, t
Legal Description
/ Lessee / Tenant
Owner's Address 1 C .c
Contracting Co.
Qualifier PoLe4:
Signature of owner and
Date: ' _ ' -/ 3 -9S
No =ry as to Owner and /or Condo Preside
• OFFICIAL NOTARY SEAL
ALFRED D MC CORMICK
NOTTARY PUBLIC STATE OF FLORIDA
** * * * * COMMISSION NO. CC33C273
MY CO MM SIGN tIP D£ -,,,.* 1 997
My Commission Expir
APPROVED:
Zoning
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
•
RQJD'F+ L, tin
Condo President
Fire
Buildi
Mechanical Plumbing,
Address
* *
Tax
Folio 1 P
Master Permit # 373 ��
Phoneme •--' iccr; 8
Address
State # Municipal # Competency.#
Architect /Engineer Jt k)
Address
Bonding Company �)f�
Mortgagor \Jh 3 e Address
? Phone 26K
,J
FEES: PERMIT ! D - -515- RADON C.C.F. /. v NOTARY
f7L(o ;AJ 1 ( a� .�
Ins.Co.
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION P S.S f ,- E r- °f - f(xnt:c -Q
On i- Loge e r h}1 o rE
Square Ft. OD O St. / A>( 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 ab ve -named contractor to do the work stated.
�t 5E
Signature of Contractor or Owner- Builder
Date: ,-f 3 95
4L1127
Notry as to Contractor or Owner-Builder
My Commission Expires:
OFFICIALNOTARY SEAL
ALFP.ED D MC CORMICK
NOTARY Y U3LIC STA;'E OF FLORIDA
* * eOMMISS? DN NO. 4C33 }273 **
MY COMMISSION EXP. DEC. 4,1997
TOTAL DUE e id • � �
Other
Electrical
Engineering