1165 NE 97 St (3), f PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date • Job Address 4 / /45 XI 77 S¢ Tax Folio
Legal Description Z„ /go Historically Designated: Yes
Owner/Lessee / Tenant X
Owner's Address t/65
Contracting Co. / s Ti l- ( G ll. e T-. Address 7 2/ //.. //.. , 11/e. w . S)eT ; r /Gu
. Phone 0 o S.) — S " / —, e f
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFIN r. PAVING FENCE SIGN
WORK DESCRIPTION - , f: — � �� .�/ �s1.� c- 1� his //d/ p �, > .;
1( illete.i
Square Ft. /5
Estimated Cost (value)
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUY
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOU:3. 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 EL3CTRICAL
PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNERS 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.
Notary : to • - • er and/or
My Co `` �14t Expires:
J�ZPA tin
a �,�_Commission ax DD 016496
.71 ) Expires Apn'1 9, 2005
Thni
' ' . 4.wig s ` Atlantic Bonded
Bonding Co., Inc.
FEES: PERMIT RADON
APPROVED:
Zoning aid / suit
Notary as
My Commis ion
Master Permit # *' 3
Phone(36 ) a,P 236 C,/
Electrical
C.C.F. NOTARY o 0 BOND
TOTAL DUE
No
Mechanical Plumbing Structural Engineer
Y'r%11.r0"WIN vf. vim. Vivo. y - -
A, RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERWIT H0. TAX FOLIO NO.
S trE OF FLORIDA:
COUNTY OF DADE:
THE UNDERSIGNED hereby gi, , tice that improvements will be made to certain real property, and in accordance with
CAP
tet 713. Florida Statutes, tha wing information is provided in this Notice of Commencement.
,, �'+
1. Legal description of property and street address: /WO NE 97 5/ ' 9fi J tate6
• .,T 3 Ahe f C ' / 80 5.w 4 17 1 Vi'I4✓ _.4 P V Se '' -7 ! .x .' 4../14 1 .
�-- S c. .R /fee 12 t) i d To Pe9- 7 10 >.(,. %r. .sass e n rz.c,
.4/ . el 9T PeOL ,Uo /
2. Description of improvement:
6. Lenders name and address:
4. Contractors name and address:
,/yI aAV ? 3/‘
3.Owner(s) name and address:'
F/ 331
Interest in property: >
Name and address of fee simple titleholder: 4- v'may 1444 / // b �l s 9 7 t �'` � ,4..a ;
5. Surety:(Payment bond required by owner from contractor, it any)
Name and address:
Amount of bond:
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided
by Section 713.13(1)(a)7.. Florida Statutes,
Name and address:
8. In addition 10 himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in
Section 713.13(1)(b). Florida Statutes.
Name and address:
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
tiffyEldr date is specified)
(A‘ ,de
Signature Owner
Print fs Name
Sworn to and subscribed ;;ore = this
Notary Public
Print Notar Name
My Commission Expires
STATE OF FLORIDA, COUNTY OF DADE
HEREBY CERTIFY the this is true GM GP tho
original filod to this ofte on day of
"4 6, AO 20 /Pi
WITNESS my hand and Official Seal.
HARVEY RUVIN,S ER 'mud and County Courts
BY. 4- o®/ f -- D.C.
1R33 1648 2001 JUN 26 09143
1 die /QU ri4 '7i ro A/4T a7AJ 33/4 .
Prepared by ./124,./Z._.446.0--
Address: 1 ✓ /-#-
04'4icx. 0 at' 1/e,
AA-
STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affiant, a 'v4.7, e. , does hereby attest that the
(property owner)
attached survey, performed by Aid //,¢
performed one' is an accurate representation of the existing conditions and
(dat =. of survey)
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the
property without first providing a survey less than six (6) months old. The Affiant, as property owner, further
agrees to remove or obtain permits for any structures which now may exist on the property which are not
permitted or which may violate zoning or building code regulations. The Affiant further understands that the
existence of any such structures may affect final inspections as applicable to this or other permits..
Furt -r, Affiant sayeth naught.
Witness(sign a 9 print)
(
SWORN TO AND SUBSCRIBED before me this day of
Affiant is personally known to me, produced
AFFIDAVIT
e of surveyor's company)
as identification.
Damaris egrin
Commission DD 016496
cc Expires April 9, 2005
tie Bonded
Bonding Coy lac
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
WHEREAS, (2d/ Q 'e 1 ' , hereinafter referred to as the Owner of t
(owner
following described property:
Legal description/folio #:
Lot 3 Block AP° ' Subdivision £
504.6'e / $
Tax Folio #:
requests permission to install:
[''Asphalt, concrete, brick pavers
[ ] Landscaping
[ ] Other G
DRWetu A PP o✓}cr
M iami ShoreJ ag
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 -2382
Telephone: (305) 795 -2207
Fax: (3051755 -8972
e
!/g .v- y 7'
s//zed_
(address)
IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows
I . To maintain and repair, when necessary, the above - mentioned item(s) installed within th
of way. If it becomes necessary for Miami Shores Village or Dade County to make repai
items within public right of way including restoration of street by reason of_the Owner's 1
such expense shall be paid by the Owner or shall constitute a lien against the above descr
until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or dade Coun
any and all liability, which may rise by virtue of permitting the installation of these items
right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense,
notice by the Village to do so. Failure to comply with this notice will result in the Village
item(s) to be removed and a lien being placed on the property and/or assessed against the
costs incurred in the removal and disposal of the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and
shall remain in full force and effect and be binding on the undersigned, their heirs and as igns, until such
time as this obligation has been canceled by an affidavit filed in the Public records of Dade County, Florida
by the Village Manager of h fully authorized repres • tive).
within the public road right of way of /1/ 7 �
U3TIlar1 �� (
= �f = DD o ;, .
Miami s Villa e (or his u
, DGFfoy this
4 .;:: Expires Apn1 9,
, orit V Mint
SIGNED, SEAMS AAVELTOSICIOili the presence of:
STATE OF FLORIDA, COUNTY OF DADE
I HERESY CERTIFY that this is a true co y of the
da�P
original Piled irk ffice on , A D 20 it2L._ ---
WITNESS m y hand and Official Seat.
HARVEY RUVI , RIB: • .<(' : rcuit and County Courts
Sy J r / - ( - 1 D.G.
owner)
dedicated right
s or maintain said
ailure to do so,
bed property
y harmless from
w ithin the public
v ithin 60 days
causing the
Ow ner for all
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NOTES:
ART
09 9‘ ID
DADE COUNTY BRANCH
8589 N.\A' 54th Street
Miami. =L 33166
Fax (305- -718 -8933
Phone (305) 888 -9500
DATE
NAME i
ADDRESS �// 5 N� 97 s/
CITY /`/ /'2,' i SAiae Z
PHONE H- 3b5 75013/ W- 3 0-T" 6 2344
TYPE
PERMIT YES NO
COLOR T /dH REL
DESIGN b/004 gale /ct�
BORDER PLAIN /D BRICK
SQUARE FEET ST. J 5l1 . PL.
WIRE MESH FIBER MESH
B.H. _ ASPHALT _ GRASS CONCRETE
CHIPPING HAMMER SQ. FT.
BY HAND PUMP
PVC PIPES
DECO DRAIN
RAIN RECEPTOR
PRESSURE CLEAN
SAND BLASTING
DIRECTIONS:
BACK HOE $ _ ST. CREW $
FORM $ SEALER
f
' + , ueu ' T u Pent = Tf u a/ 3eue '�
5582 N W.'7th STREET, SUITE 202
MIAMI. FLORIDA 33126
T 5: Er:IGNE' x=05) 220 -3171
F 2n.
4)C..) 554 -7,822
DRAW_! BY: r t^ /! •
Survey of Lot: 3 Block: an
Subdivision: REVISED PLAT OF MIAMI SHORES SEC. 8
According to the Plat thereof as recorded in the Plat Book No. 43
at Page No. 51 of the public records of MIAMI -DADE County, Florida.
Property Address: 1165 NE 97 ST, MIAMI SHORES, FL 33138
For: CHRISTINE BENNETT ATKINSON
U
A = ARC.
NC = AIR CONDITIONER PAD.
A E. = ANCIIOR EASEMENT.
NR = AI UMINUM ROOF.
NS = At UMINUM SIZED.
ASP!' = ASPIIALT
B C = BLOCK CORNER.
BLDG = BUILDING
B M = BENCH MARK.
B 0 B. = BASIS OF BEARINGS.
C =CALCULATED.
C 13 = CATCII BASIN.
C 13 S. = CONCRETE BLOCK
STRUCTURE.
CBW = CONCRETE BLOCK WALL.
CH. = CHORD DISTANCE.
01. 8. = CIIORD BEARING.
CL. = CLEAR
C L.F = CHAIN LINK FENCE.
C M E = CANAL MAINTENANCE
EASEMENT.
CONC = CONCRETE.
C P = CONC. PORCH
C S. = CONCRETE SLAB
D E = DRAINAGE EASEMENT
U M E. = DRAINAGE MAINTENANCE
EASEMENT.
DRIVE. = DRIVEWAY.
o= DEGREES
E .. EAST.
E I P = ELECTRIC TRANSFORMER
PAD
ELEV. = ELEVATION.
ENCR = ENCROACHMENT.
F 11 = FIRE HYDRANT.
F.I P = FOUND IRON PIPE.
F I R = FOUND 1801130D.
F F E = FINISHED FLOOR
ELEVATION
!'4' $rn JJ rn4.
LAND SURVEYORS
LOCATION SKETCH Scale 1" = Nr .
'Nock l&)
b 1 i G
ABBREVIATIONS AND MEANING
F.N.D. = FOUND NAIL & DISK
FR. = FRAME.
FT. = FEET.
FNIP. = FEDERAL NATIONAL
IITSURANCE PROGRAM.
F.N. = FOUND NAIL.
H. = HIGH (HEIGHT).
IN 8 EG. = INGRESS AND EGRESS
EASEMENT.
L.P. = LIGHT POLE.
L F.E. = LOWEST FLOOR
ELEVATION.
L M.E. = LAKE MAINTENANCE
EASEMENT.
' = MINUTES.
M. = MEASURED DISTANCE.
MON. = MONUMENT.
M/I1. = MANHOLE
M/L. = MONUMENT LINE.
N.A.P. = NOT A PART OF.
NGVD= NATIONAL GEODETIC
VERTICAL DATUM.
N = NORTH.
N T S. = NOT TO SCALE.
0 • NO. = NUMBER.
0 /S. = OFFSET.
011. = OVERHEAD.
0 11 L.= OVERHEAD UTILITY LINES
OVII = OVERHANG.
0 R 13 = OFFICIAL RECORD BOOK.
PVMT. = PAVEMENT.
PL. = PLANTER
P/L = PROPERTY LINE.
P C.C. = POINT OF COMPOUND
CURVE
P.C. = POINT OF CURVE.
PT. = POINT OF TANGENCY.
POC. = POINT OF COMMENCEMENT
POB. = POINT OF BEGINNING.
•
LEGAL NOTES TO ACCOMPANY SKETCH OF SURVEY (SURVEY):
EXAMINATION OF TIIE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED
IFIS TRUMEIITS, IF ANY, AFFECTING THE PROPERTY THIS SURVEY IS SUBJECT TO DEDICATIONS.
LIMITATIONS. RESTRICTIONS, RESERVATIONS OR EASEMENTS OF RECORD LEGAL DESCRIPTIONS
fII " ^p+11 tt" 11TIII nfl n, fTSTHIr: TITI r rr111P
P.R.C. = POINT OF REVERSE
CURVE.
PROP. COR. = PROPERTY
CORNER.
P 8 = PLAT BOOK
PG = PAGE.
PWY =PARKWAY.
PRM = PERMANENT REFERENCE
MONUMENT.
P L.S. = PROFESSIONAL LAND
SURVEYOR.
13.. RECORDED DISTANCE.
R13. = RAILROAD
RES. = RESIDENCE.
RIGHT- OF•WAY.
RAD. = RADIUS OR RADIAL.
R P = RADIUS POINT.
RGE = RANGE.
SEC. = SECTION.
STY. = STORY.
SWK. = SIDEWALK.
S.I P. = SET IRON PIPE L B. 06044
S = SOUTH.
S =SET NAIL 8 DISK LB 06044
SP. = SCREENED PORCH.
" =SECONDS
T. = TANGENT.
TWP. = TOWNSHIP.
U E. = UTILITY EASEMENT.
UTIL. = UTILITY
U P. = UTILITY POLE.
W M. = WATER METER.
W.F. = WOOD FENCE.
W.S. = WOOD SHED.
= CENTRAL ANGLE
W. = WEST.
= CENTER LINE.
= ANGLE.
WOOD FENCE.
CHAIN LINK FENCE.
CBS WALL(CBW.)
EXISTING ELEVATIONS.
0.00 x
—J
SURVEY No.
SHEET NO
LEGEND TYPICAL
SURVEYORS'S NQTES`1) IF SHOWN, BEARINGS ARE
REFERRED TO AN ASSUMED MERIDIAN, BY SAID PLAT
IN THE DESCRIPTION OF THE PROPERTY. IF NOT,
THEN BEARINGS ARE REFERRED TO COUNTY
TOWNSHIP MAPS.
2) IF SHOWN, ELEVATIONS ARE REFERRED TO
3) THIS IS A SPECIFIC PURPOSE SURVEY.
4) 11 CLOSURE IN THE BOUNDARY SURVEY IS
ABOVE 1:7500 FT.
I HEREBY CERTIFY: THAT THIS 'BOUNDARY SURVEY'
OF THE PROPERTY DESCRIBED HEREON, AS
RECENTLY SURVEYED AND DRAWN UNDER MY
SUPERVISION, COMPLIES WITH THE MINIMUM
TECIINICAL STANDARDS AS SET FORTH BY
THE FLORIDA BOARD OF PROFESSIONAL LAND
SURVEYORS IN CHAPTER 61017-6. FLORIDA
ADMINISTRATIVE CODE PURSUANT
TO 472 027, FL IDA STATUTES. /
q8- 0004873
of
Date: 07/11/1998
f4 ,
PROPOSED ELEVATIONS
•
B M 0 ELEV.
OFNG.VD OF1929
BY:
68-0iQ6E IBARRA (DATE OF FIELD WORK ' /2
PROFESSIONAL LAND SURVEYOR NO. 2539
STATE OF FLORIDA (VALID COPIES OF THIS SURVEY WILL
BEAR THE EMBOSSED SEAL OF THE ATTESTING LAND
SURVEYOR)
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5582 N W.'7th STREET, SUITE 202
MIAMI. FLORIDA 33126
T 5: Er:IGNE' x=05) 220 -3171
F 2n.
4)C..) 554 -7,822
DRAW_! BY: r t^ /! •
Survey of Lot: 3 Block: an
Subdivision: REVISED PLAT OF MIAMI SHORES SEC. 8
According to the Plat thereof as recorded in the Plat Book No. 43
at Page No. 51 of the public records of MIAMI -DADE County, Florida.
Property Address: 1165 NE 97 ST, MIAMI SHORES, FL 33138
For: CHRISTINE BENNETT ATKINSON
U
A = ARC.
NC = AIR CONDITIONER PAD.
A E. = ANCIIOR EASEMENT.
NR = AI UMINUM ROOF.
NS = At UMINUM SIZED.
ASP!' = ASPIIALT
B C = BLOCK CORNER.
BLDG = BUILDING
B M = BENCH MARK.
B 0 B. = BASIS OF BEARINGS.
C =CALCULATED.
C 13 = CATCII BASIN.
C 13 S. = CONCRETE BLOCK
STRUCTURE.
CBW = CONCRETE BLOCK WALL.
CH. = CHORD DISTANCE.
01. 8. = CIIORD BEARING.
CL. = CLEAR
C L.F = CHAIN LINK FENCE.
C M E = CANAL MAINTENANCE
EASEMENT.
CONC = CONCRETE.
C P = CONC. PORCH
C S. = CONCRETE SLAB
D E = DRAINAGE EASEMENT
U M E. = DRAINAGE MAINTENANCE
EASEMENT.
DRIVE. = DRIVEWAY.
o= DEGREES
E .. EAST.
E I P = ELECTRIC TRANSFORMER
PAD
ELEV. = ELEVATION.
ENCR = ENCROACHMENT.
F 11 = FIRE HYDRANT.
F.I P = FOUND IRON PIPE.
F I R = FOUND 1801130D.
F F E = FINISHED FLOOR
ELEVATION
!'4' $rn JJ rn4.
LAND SURVEYORS
LOCATION SKETCH Scale 1" = Nr .
'Nock l&)
b 1 i G
ABBREVIATIONS AND MEANING
F.N.D. = FOUND NAIL & DISK
FR. = FRAME.
FT. = FEET.
FNIP. = FEDERAL NATIONAL
IITSURANCE PROGRAM.
F.N. = FOUND NAIL.
H. = HIGH (HEIGHT).
IN 8 EG. = INGRESS AND EGRESS
EASEMENT.
L.P. = LIGHT POLE.
L F.E. = LOWEST FLOOR
ELEVATION.
L M.E. = LAKE MAINTENANCE
EASEMENT.
' = MINUTES.
M. = MEASURED DISTANCE.
MON. = MONUMENT.
M/I1. = MANHOLE
M/L. = MONUMENT LINE.
N.A.P. = NOT A PART OF.
NGVD= NATIONAL GEODETIC
VERTICAL DATUM.
N = NORTH.
N T S. = NOT TO SCALE.
0 • NO. = NUMBER.
0 /S. = OFFSET.
011. = OVERHEAD.
0 11 L.= OVERHEAD UTILITY LINES
OVII = OVERHANG.
0 R 13 = OFFICIAL RECORD BOOK.
PVMT. = PAVEMENT.
PL. = PLANTER
P/L = PROPERTY LINE.
P C.C. = POINT OF COMPOUND
CURVE
P.C. = POINT OF CURVE.
PT. = POINT OF TANGENCY.
POC. = POINT OF COMMENCEMENT
POB. = POINT OF BEGINNING.
•
LEGAL NOTES TO ACCOMPANY SKETCH OF SURVEY (SURVEY):
EXAMINATION OF TIIE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED
IFIS TRUMEIITS, IF ANY, AFFECTING THE PROPERTY THIS SURVEY IS SUBJECT TO DEDICATIONS.
LIMITATIONS. RESTRICTIONS, RESERVATIONS OR EASEMENTS OF RECORD LEGAL DESCRIPTIONS
fII " ^p+11 tt" 11TIII nfl n, fTSTHIr: TITI r rr111P
P.R.C. = POINT OF REVERSE
CURVE.
PROP. COR. = PROPERTY
CORNER.
P 8 = PLAT BOOK
PG = PAGE.
PWY =PARKWAY.
PRM = PERMANENT REFERENCE
MONUMENT.
P L.S. = PROFESSIONAL LAND
SURVEYOR.
13.. RECORDED DISTANCE.
R13. = RAILROAD
RES. = RESIDENCE.
RIGHT- OF•WAY.
RAD. = RADIUS OR RADIAL.
R P = RADIUS POINT.
RGE = RANGE.
SEC. = SECTION.
STY. = STORY.
SWK. = SIDEWALK.
S.I P. = SET IRON PIPE L B. 06044
S = SOUTH.
S =SET NAIL 8 DISK LB 06044
SP. = SCREENED PORCH.
" =SECONDS
T. = TANGENT.
TWP. = TOWNSHIP.
U E. = UTILITY EASEMENT.
UTIL. = UTILITY
U P. = UTILITY POLE.
W M. = WATER METER.
W.F. = WOOD FENCE.
W.S. = WOOD SHED.
= CENTRAL ANGLE
W. = WEST.
= CENTER LINE.
= ANGLE.
WOOD FENCE.
CHAIN LINK FENCE.
CBS WALL(CBW.)
EXISTING ELEVATIONS.
0.00 x
—J
SURVEY No.
SHEET NO
LEGEND TYPICAL
SURVEYORS'S NQTES`1) IF SHOWN, BEARINGS ARE
REFERRED TO AN ASSUMED MERIDIAN, BY SAID PLAT
IN THE DESCRIPTION OF THE PROPERTY. IF NOT,
THEN BEARINGS ARE REFERRED TO COUNTY
TOWNSHIP MAPS.
2) IF SHOWN, ELEVATIONS ARE REFERRED TO
3) THIS IS A SPECIFIC PURPOSE SURVEY.
4) 11 CLOSURE IN THE BOUNDARY SURVEY IS
ABOVE 1:7500 FT.
I HEREBY CERTIFY: THAT THIS 'BOUNDARY SURVEY'
OF THE PROPERTY DESCRIBED HEREON, AS
RECENTLY SURVEYED AND DRAWN UNDER MY
SUPERVISION, COMPLIES WITH THE MINIMUM
TECIINICAL STANDARDS AS SET FORTH BY
THE FLORIDA BOARD OF PROFESSIONAL LAND
SURVEYORS IN CHAPTER 61017-6. FLORIDA
ADMINISTRATIVE CODE PURSUANT
TO 472 027, FL IDA STATUTES. /
q8- 0004873
of
Date: 07/11/1998
f4 ,
PROPOSED ELEVATIONS
•
B M 0 ELEV.
OFNG.VD OF1929
BY:
68-0iQ6E IBARRA (DATE OF FIELD WORK ' /2
PROFESSIONAL LAND SURVEYOR NO. 2539
STATE OF FLORIDA (VALID COPIES OF THIS SURVEY WILL
BEAR THE EMBOSSED SEAL OF THE ATTESTING LAND
SURVEYOR)
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Street and Number where work is to be done
Permit No
Disapproved
(Signed)
materials and /or workmanship.
Building I pector
Chairman
Member
Member ...._ ..
Council Approved Date
Read, Sworn to
PLANNING BOARD DATE
IP
MIAMI SH il 6 " ES ° LACE
BUILDING INSf ECTION D PIS TPv1ENT
APPLICATION F. (IU L! ING PERMIT
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.
f
Owner's Name and Address.... �.0 ��f_ No._ _ //�_ �? Street
Registered Architect and /or Engineer....._
Name and address of licensed contractor !
Location and legal description of lot to be built on:
Lot Block . '' Subdivision... -._
Date__ -- Zz1 _.._d__�l - r
State work to be done and purpose of building (by floors)
and for no other purpose.
New Building Remodeling Addition Z Repairs No. of Stories
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 subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed) d___,: ' v�
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 described construction, that he has carefully read the foregoing application,
therein by him stated are tru
r
Date
Date
and that he did sign the same, and that all facts
and Subscribed before me.
,19
Notary Public, State of Florida
My Commission Expires
Member
Member
Member
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