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PAINTC lAaViir 9 11 9 SHORES VILLAGE 4 7 Are mitia INSPECTION DEPARTMENT f FOR BUILDING PERMIT ment of the plans and specifications herewith submitted for the building or other structure herein di th the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the g and regulations of the Building Division of Miami Shores Village shall be complied with. whether must be kept at building during progress of the work. and for no other purpose. _ Addition Repairs No. of Stories foundation Roof Covering Amount of Permit $ 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 '73 3 S ; S L3 , r = 6 The undersigned applicant for this building permit does hereby certify that he understands and accep Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, compliance from all contractors or sub - contractors employed by him in the work to be performed on the site of the work such public notice or notices as are required by the Act. The undersigned under this permit, as are licensed by Miami Shores Village. 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 appeared 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 Disapproved (Signed) c) Date CO °1 /l) Building Inspector n ,c (5 7iwg2) 2-7 g•- I T 5 terior colors (submit samples) Date Date l No. /_2 7 Street ef.LccaL.4=)(Z.-- 1- i 're W' E%9 / obligatons as an employer of Labor under the Florida Workmen's 'ed with the provisions thereof, and will require similar o or cause to be posted for inspection ontractors, on work to be performed Read, Sworn to and Subscribed before me. PLANNING BOARD DATE Notary Public. State of Florida �' cl 9 . to me well known. My Commission Expires Chairman Member Member Member lember Member mcil Approved Date Disapproved Date )TE: A charge of 625.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. -inspection fee of $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and or workmanship. Date , ! l/"`vvTiv Tax Folio // ,9 1. /3 ,Z(h' Legal Description /q h ✓' / C) /' . eei l Owner / Lessee / Tenant 6a/ (C. A a IAr1 J kLtt= / lc )' 4iitd Master Permit #,9 , Owner's Address /0/7 AJC *7 'S?' Phone 7c 753 Contracting Co. avf?e/2 Address Qualifier SS# - - Phone ? 7- � -, S 9 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 /3//?1 ��k�P/i' ( /7" -1u_ S'c? i' /7nJ Square Ft. Estimated Cost(value) ?). - U v 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 authorizi'the above d contractor to do the work stated. it nature of te: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Notary as to Owner and /or Condo President My Commission Expires: ** * * * FEES: PERMITI/ .j 76, APPROVED: owner and /or Condo President RADON Zoning Ga f a reof Contractor or Owner - Builder te: / 9 it '> ?r °,9ro $..• No. CC197545 tary as to C y Commission ** * C.C.F. j2 NOTARY 6,G ©W TOTAL DUE 4 0' 0 Fire Mechanical Plumbing Engineering_ Other Electrical Date 5 Legal Description _ Yes No Owner/Lessee / Tens; er Permit # Owner's Address .737 7— 7 Contracting Co. tic Qualifier c ( S /= Phone State # Architect/Engineer Bonding Company Mortgagor Permit Type (circle o) WORK DESCRIPTI( Square Ft. )zi WARNING TO OW1 RESULT IN YOUR PA CONSULT WITH YO hire of owner and/or Condo President Notary as to Owner and/or Condo President Date My Commission Expires: FEES: PERMIT Va. RADON 9C– D to )RES VILLAGE ROOFING PAVING FENCE SIG Ins. Co. Application is hereby r wou anu mstallauon 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 an ng. Furl}ermore, I authorize the above -named contra tor to do the work sta Si a e of Contractor .r Owner- Builder Date otag as to Contractor or Owner - Builder �F „ < • n SAKORA ; �tU r '. c V. * COMM 3s:OA' 4�NE "1 0 CC4 W26E� �r� " ¢, NY COMPAISe d urn ' AND YOUR FAILURE TO DO SO MAY YOU INTEND TO OBTAIN FINANCING, NOTICE OF COMMENCEMENT.) 1- ) - y' " Date AUG. 17 ,;SOrli C.C.F. y 5 NOTARY - va TOTAL DUE APPROVED: Zonin g Building Buildin \ �' ( u Electrical Mechanical Plumbing Engineering PROPERTY OWNER Name p 1M 1 i J (-1-t �_ j'- e I Address I a j,. 6 e - ,St IA(a 6,i+6f-es Pi Home Telephone 30 5 s -?_ 7 , Business Telephone 3 s L c 2 _ i l x Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other Step 1. Job Address: Address Apt. Folio Number /43' IP D , 3 ° R- L /60 0 Lot l3 e IA � dBlock Subdivision 5 t°C j 1'G / 0 Current Use of Property @� Proposed Use of Property ' 1 Tenant Information jD1 Ns q - S+ PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax i3 P or r PERMIT APPLICATION E Master Permit No. Subsidiary Permit No. INSTRt CTIONS - The following steps ti iiist he taken to obtain a permit from the Shores Village: Complete the attached permit application which must be i ' ned b the ro ,ert owner and • ualifier. Both si nature must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. Step 2. submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. N1 Arm c SI4 vieks l- City State 3'f Zip "Description of Work PA-/ 7 14 - •1 - o lA < Zoning Linear Feet Square Feet Units Floors Hof Work 9 1)0 Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name SECTION BY `j DATE Zoning I j y7 Electrical Mechanical Plumbing Fire Public Works Structural Building Official ,,2./ /2 20 Of Page 4 OFFICE USE ONLY i•ri :CK • OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) $ o P lJ ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $ $ (� 0 . 0 0 Inspector State Educational Fund $ (¢.005 /sq.ft.) State DCA (Radon) Code Enforcement Fine Zoning Review $ (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: (sq.ft. = x/1000 x ¢.60) PERMIT APPLICATION la CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ ( ( v DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2N AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com