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1279 NE 97 St (11)4 PERMIT APPLICATION FOR MUNICIPALITIES OF DADS C..UNTY (OWNER TO RETAIN COPY) Date Legal Description �B d R _ en����� _ Oe�n / Lessee / Tenant�3 8n r.Nr�r1Gri.a gorz« Owner's Address . - i q n ) 640 Q1, -- Contracting Co. A tx LIZMOL-) Qualifier State# Architect /Engineer Bonding Company Mortgagor Permit Type (circle one) WORK DESCRIPTION Square Ft. Signature Date: Notary My Commi * PERMIT FEE: Zoning Mechanical • 1 er and /or Condo President ne and/or President. on Ex i ll / /ed NY C,Qru ciSTO EIT. .17.1 APPRO 3 E 0 IKRU am" El'S. rtSn. F i -re SS #2 Buildin Plumbing Address Estimated Cos 1040 Notary as to Co My Commission 71v/141v • Tax Folio 0 Lel 849-4 Master Permit # ✓ c2 P Phone TJ Z -Osc5 Competency # G COT C:0 61 (O Ins.Co. C Q . MR Address 1 (0A .t) s 3� Address Address BUILDING ELECTRICAL PLUMBING MECHANICAL 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 sill work will be performed to meet the standards of all lava 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 end zoning. Furthermore, I authorize the above -named contractor to do the work stated. o. or Ownf r -B i der es: �c' ar a zL ItOTAAIGLICS117, ! f ' .1i1161 oth SSIO EISP. Electrical Engineering t4 . 51 3 5 ib5 NOTICE OF COMMENCEMENT PERMIT NO. TAX FOLIO NO. STATE OF FLORIDA: �L COUNTY OF DADE: ph,(> 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 descrip ion of property and street address: 45 r9 2. Description of improvement: \ ,(711E2E1 \ Epvi p ..E. FD I J / S LJ - 3. Owner(s) name and address: l Wl F_S ( 51elts.F 2_7Q . F. q S — Interest in property: Notary Public Print Notary's Name My Commission Expires: Name and address of fee simple titleholder: 4. Contractor's name and address: 1\/1 AT L-1,Dr h1.4S 1 L940 ' " 41 sT 5. Surety:(Payment bond required by owner from contractor, if any) Name and address: • Amount of bond $ 6. Lender's name and address: 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 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 different date is specified) Signature of Owner y� Print Owners Name �S f'J0 )1 .� 7 Prepared by: M k:7 +NbNNA, Sworn to and subscribed b: •re me thi (Q day of , 19 q z__. Address: 1(4740 xI Art 5 4--- se ' NOTARY PUBLIC STATE or n MUM, CmnruSSTON EXP. SEPT. f 7, 198 QED THRU ORAL INS. U1IO. STA'P_ -. I L ::OH COU 'i .Y I HER ue EDY CERTIFY that this is a tr copy of the origin filed ( office on ay of A.D. 19 Y WITN d and Official Seal. Clerk Circuit Court 928288261 1992 JUL 28 08 :31 Owner's Name and Address.. MIAMI SH` 'RES V0L_LAGE BUILDING INSPECTION DEPARTMENT APPLICATION F• , =r BUILDING 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. Q' Date �Q , 19.� No AR . f �4C Street d-_ Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done 7 State work to be done and purpose of building (by floors) / /0.- - CZ. S .uiC o. ao .e" 6E and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind o fouuj tion Covering Estimated Total cost of improvements $ t" 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 thereot, 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 p formed under this permit, as are licensed by Miami Shores Village. Remarks ( Signed) i /�► ' uilding 'Q` ctor STATE OF FLORIDA, COUNTY OF DADE. j 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, and that he did sign the same, and that all facts therein by him stated are true. Permit No T 7 O 7 Date lO – z — ( Read, Sworn to and Subscribed before me. Disapproved ( Signed) (,t Notary Public, State of Florida My Commission Expires PLANNING BOARD DATE Chainnan - Member Member Member Member 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.