1249 NE 97 St (5)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date / -/5-9k Job Address / oZ T , /L k-7 97,4 Tax Folio
Legal Description Historically Designated: Yes No
Own /Lessee / Tenant _ //ri ( Pfl1 )1, /0 Master Permit #
Owner's Address /A NL q7, P e 7 - 06o /
Contracting Co. Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
Square Ft. / — 700
Notary as to Owner and/or Con
My Commission Expires:
FEES: PERMIT
o Presi
(r„
47`" 1lWA e iM
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.
Signature owner and/or Condo President Date Signature of Contractor or Owner - Builder Date
ent Date
///the
APPROVED:
Zoning Building
Mechanical Plumbing Engineering
Estimated Cost (value) 40 O 0
Notary as to Contractor or Owner - Builder Date
My Commission Expires:
Electrical
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PROVED BY
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SUBJECT TO.COMPLIANCE WITH ALL FEDERAL STATE AND COUP
RULES .ti\Ii REGULATIONS.
MIAMI SHORES VILLAGE A SU VES 4dU RESPO? I:B LlTIES FOR ACCURACY
CF OR RESULTS FROM T1:E`• ' FU S.
;011P1,9AIICE TO THE SOUTH FLORIDA BUii 17AG CODE AS ADOPTED BY
MIAMI SHORES VILLAQE IS REQUIRED. THE AlcCHITECT, BTIDER & >"
COPiTRACTORS ARE CHARGED WITH TEE KNOVkILEDCF. OF ALL i UILDINC
REGULATIOSJS LIMETNER OR NOT SFECIFICALL'i iND1CATED HEREIN.
PE -2
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ENG1JSH IVORY 17
EXTERIOR POPULAR
READY -MIXED COLORS
Available In:
• MoorLife 105 • MoorGard 103
• MoorGlo 096 • Moore's House Paint 110
Since all chips are affected by age. tight. heat and
mechanical coating processes. this chip may vary
slightly in color or finish from the actual
Paint in the container.
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PANTS
Benjamin Moore & Co.. Montvale, NJ 07645
New York Office. 511 Canal Street
Manufactunng locancns in Newark • Boston • Pichmond
Jacksonville • Johnstown • Cleveland • Chicago • SL Louis
Dallas • Birmingham • Denver • Los Angeles
Toronto • .Montreal • Vancouver • Auckland
Litho in U.S.A.
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Benjamin .ocre 1 C... Montvale. NJ 07645
S�;v :1t Canal Street
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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.
„�wner's Name and Address
Registered Architect and/or Engineer
Name and address of licensed contractor
Location and legal d scription of lot to be built on:
Lot / 5 ' W cg# Block
—Street and Number where work is to be done t`" Z C ! f
✓ State work to be done and purpose of building (by floors), state exterior colors (submit samples)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Subdivision 4_4./ `.
z..-Date l Z 7 5 /J 19 t
NIX // Stre - e
// ,x.,255' O9 O57/
-
and for no other purpose
New Building Remodeling Addition Repairs No. of Stories
Kind of foundation L�' Roof Covering
Estimated Total cost of improvements S ' .5 CJ Amount of Permit S ` 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
To be constructed of
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 subcontractors. on work to be performed
under this permit as are licensed by Miami Shores Village
Remarks w (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 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 art true.
Permit No
Disapproved
(Signed)
Date
Date
Read. Sworn to and Subscribed before me.
Notary Public. State of Florida
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of 525.00 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 525.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and or workmanship.