130 NE 97 St (9)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.
Owner's Name and Address
Registered Architect andior Engineer
Name and address of licensed contractor
MIAMI SHORES VILLAGE ,iaAj Pe
BUILDING INSPECTION DEPARTMENT 751 �
APPLICATION FOR BUILDING PERMIT
Location and flegal Q
descrip ion of lot to be buil on: lee//
Lot k "i / L WS Block Subdivision /-DIY / R r "U/ 1/ S .2o4 /3 2sI� 6'g
to exterior colors (submit samples)
Street and Number where work is to be done
State wok to be done and purpose . qf building (by floors), s
and for no other purpose.
New Building Remodeling
To be constructed of Kind of foundation
Estimated Total cost of improvements S /1(Y�-' ou Amount of Permit S
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
Addition
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 subcontrac .rs, on work to be performed
under this permit, as are licensed by Miami Shores Village.
Remarks (Signed)
7 LI
Permit No.
Disapproved
(Signed)
Date
Date
Repairs No. of Stories
Date 1 /C”
Read“ Sworn to and Subscribed before me.
2- -
No. P ,3a Street
Roof Covering
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 are true.
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 $25.00 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 S25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship.
Po OE Crl
/- /C4r
FEES: PERMIT RADON
SS# Phone
r f S C / /4 _ Competency # Ins. Co.
L3 C %(4N' -
Address
Address
Address
Signature of owner and/or Condo President Date
FOR MIAMI SHORES VILLAGE
Tax Folio
Notary as to Owner and/or Condo President Date Notary
My Commission Expires: My Co
_ Historically Designated: Yes No
Master Permit # y 6
Phone tea S- S 9 5
Address
LING MECHANICAL ROOFING PAVING FENCE SIGN
S C 4j re — AS v
Estimated Cost (value)
DF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
LE 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.
Sj e of 04 , ctor or Own
• o ° ilder
•� <
C.C.F. NOTARY
Builder Date
BOND
TOTAL DUE
iciak,Rd
Date
APPROVED:
Zoning Building � � f7 1 e Ye Electrical
Mechanical Plumbing Engineering