FENCEDate Job Address
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
12LI ) �. lP - Tax Folio /1 3 a¢' 37
Legal Description Historically Designated: Yes No
Ow er}Lessee / Tenan f 5 g oer P1 / Master Permit # 432 Z
2
Owner's Address ) _ Li 5 1\1_, 6 169 , .rT rte Phone ( - 7.5S - ?,y ? . Cf
Contracting Co. 5 uo-e J5 y) rg-P( Address
Qualifier OU.Jner SS# Phone( 3O I — 1 58 ?J4 ?9
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company \1 Ici Address
Mortgagor NI in Address
Permit Type (circle one): UILDITNT6 ELECTRICAL PLUMBING MECHANICAL ROOFING PAVIN P FENCE IGN
WORK DESCRIPTION 22° I .' C J C i, L; n . F y Q
V f f C_ )051►)C, 1 ) C C
5`�QJC� <1'173• -1 s •/ P1/K, r 3 C' Two ,J oo
Square Ft Estimated Cost (value) 4) I O0
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
regulating construction and zoning. Furthermore, I authorize the above- name tractor to do the ork stated.
o o r and/or Condo Preside
11
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ary as to er and/or Co do President
My Commission Expires:
Signature
FEES: PERMIT 1 7 4 9 RADON
ROSEMARIE MALONE
MY COMMISSION # CC 698718
EXPIRES November 25, 2001
o � ° � BdtWed Thru Notary Public Underwriters
APPROVED:
Zoning k Buildin
Mechanical Plumbing
/0AP
Date
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Date
Sign
C.C.F. / '� NOTARY BOND
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No 1 asto Con actor or Owner
My Commission xpires:
/
ntracfor or Owner- Builder
;.`•fi ,,,,, ROSEMARIE MALONE MY COMMISSION # CC 698718
e , EXPIRES: November 25, 2001
. ":1; o� t, Bonded Owl, Nowy Public UnderwAtAs
Electrical
uilder
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'¢ Engineering
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SHED-
CONC. COL.
ASPHALT
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• 5 Q . 41 AREA
PAVEMENT
FOUNTAIN
10
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SKETCH OF SURVEY
SCALE 1��= 25
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P A V E M E N T
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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.
Owner's Name and Addres
APPLICATION FOR BUILDING PERMIT
MIAMI sHoRrEs V LLAGE
BUILDING INSPECTION DEPARTMENT
Registered Architect and /or Engineer
Name and address of licensed contraetor.4Z. %S G .20x s - ' - 2.0..i L1✓. ..2. -
Location and legal description of lot to be built on:
Lot Block Subc vision
Street and Number where work is to be done / , JI2 > `� 9 A&) - ,
State work to be done and purpose of building (by -
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 $ -� ,_ c?__c) Amount of Permit $__ _L�?_
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 contractor sub - contractors a iployed by him
in the work to be performed under this permit; and will post or cause to be posted for insp cti • ory to site of the work ch public notice
or notices as are required by the Act. The undersigned agrees to employ only such subco ors, ? Work to be p ormed 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
peared
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.__._ !. Date
Disapproved
(Signed) L.) Build ng Inspector
y /
Date__
Date... - ✓
L.1 No../r Street
oaths and take acknowledgments,
Read, Sworn to and Subscribed before me.
personally op-
--to me well known,
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman 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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
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