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1200 NE 96 St (13)cy MIAMI SHORES VILLAGE e`d vc• .r' BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approyal 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. Date 3- t_1 , 19.4 k Owner's Name and Address._.F ge.fl µa S E No._!. 'Zoo . _. Street N - E • 9 41" ST Registered Architect and /or Engineer_. _ . '"_.____ Name and address of licensed contractor. p'."1 -_ 1 5.0aakte a/C . Location and legal description of lot to be built on: Block _ -. . Subdivision_. Street and Number where work is to be done 1 O° tJ • t • 1Co - S 7 . Lot State work to be done and purpose of building (by floors )..1 t !.S_T_r_s.4..• 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 $...3 °0 Amount of Permit $ '2 . c, c:, _Plan Cubage__, Size of Building Lot Zone cubage required Distance to next nearest building Maximum live load to be borne by each floor__. I hereby submit all the plans and specifications foi said building. All notices with reference to the building and its construction may be sent to -__._ _ The undersigned applicant for this building permit doe 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, Pennanent 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 ublic 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. A�} t Remarks -- -- - - -- (Signed) SGd e-11 STATE OF FLORIDA, COUNTY OF DADE. ss Before me, .:: 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, and that he did sign the same, and that all facts therein by him stated are true. Permit No 1_�l� l _ Date -__ 3 ° -__9 - 6i Read, Sworn to and Subscribed before me. Disapproved .._. _ _ _ Date._ _. ��( Notary Public, State of Florida (Signed) __hi- _ _ 1 ; - ‘_ _ . - el'' � % -- - -- - - Building Ins ctor My Commission Expires__ / PLANNING BOARD __ . DATE 4i - z. el � 4 .7` A"e • I - I N . P. A /c. . Chairman Member Member Member Member . Member Council Approved .. Date Disapproved Date NOTE: A charge of $100 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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 3 Job Address (Zoc % SST— Tax Folio C+ C O ! 3 l q E 0 Legal Description (� Owner/Lessee / Tenant pt.) d Ie ( ( Owner's Address 1 2° U X` & 5r Contracting Co. A. ti &AA. Qualifier TSO C [)t s State # l (q •C 4C 0 C (/q 3 Municipal # WORK DESCRIPTION 2 - t : c;,,c otary as to Owner and/or Condo President My Commission Expires: FEES: PERMIT t Q RADON APPROVED: Zoning Mechanical /e-/ an ondo President Date A‘2 Cow - t , L1 / Phone me' S Competency # Ins. Co. /C Q " 1' 4*- t, Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING ECHANICAIL ROOFING PAVING FENCE SIGN 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 contract • to do the work stated. b)- otary as to Contractor or Owner - Builder Date My Commission Expires:. , 3 <¢'6 SI 0iAIE OF FLORIDA, Gf,)UNTY OF DADE lb* • HEREBY CERTIFY that this is o t +� _ al ��Y _ rlginal led in this office on Q T Y \- '\C.` , A O. 19 SS r hand rid C 'idol Seal. f ircuit and County Courh D.C. _________ NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO.,/ , %30 /9/1lOd STATE OF FLORIDA COUNTY OF DADE THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street address* / c99 We. q, . g/Am S / ,/ 33/3r 2. Description of improvement' ,e //J�/9CE419P4t ©/ /5 (D47; 1 //l/6' SyS.7b. 3. Owner(s) name and address* W Da Ale /71/,44/ a .3.3/37 Interest in property* /1/0/Y Name and address of fee simple titleholder: 4. Contractor's name and address: f 4'2 � , I /he d 744 /lit re of Owne 12301.12 7194 PAGE 3 L�R „See) 75 717/E //J2 /%9 »i 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: Amount of bond* $ 6. Lender's name and address' /V 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 to himself, Owner designates the following person(s) to receive a copy of the Uenor's Notice as pro- vided in Section 713.13(1)(b), Florida Statutes. Name and address: 0 A Pr nt 0 ner's Name Sworn to and subsc : • before me thi 'day of , 19 Notary Public �1,1�.!�� ' Print Notary's Name _ My Commission Expires' NOTARY PUBLIC STATE OF FLORIDA COMMISSION NO. CC444492 MY COMMISSION EXP. MAR. 1 1 96R234702 1996 MAY 31 1154 ,/ 33 /. -3- D 9. Expiration date of this Notice of Commencement (the expiration date is 1 year from the date of recording unless a different date in specified) Prepared by: ' To f' (Il 4.3v1 > Address: U� 5/4 S'✓ -7C A Vf 1 /41 FAO . ■pdikipti 3 ) ;S-