444 NE 96 St (4)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Signature of er and)'e- Condo
Da • a//0L/P.)--
Notary as to Owner and /or Condo
My Com�nOTARY PUBLIC FLORIDA
MY COMMISSION EXPIRES 5/09/94
** * Bondedihru Ste*ler -Adanw & Sweet *
Job Address ( 9C s/ Tax Folio ii/ 3. ®f /D
Legal Description �(O 6 / v '/7 // /✓ ,6 /J4 ��` ,'.' . e ,'
Owner / Lessee / Tenant
Owner's Address 4L t / 5 C-•
Contracting Co . / 00 / 24/, * 11CC ✓L// - �QQ
Qualifier of i/
State # /
Architect /Engineer Address
� r
/ ks0 ss# Phone et 199
Municipal # ,Z
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRI PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION h?./'v / e d
Square Ft. T T Estimated Cost(value) 8
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 constructio ning. rmore, I
authorize the above -named contractor to do the work stated.
President/ / Q , Udg X24 &_ai nature of Contr• ctor or er- Builder
Print type or stamp name of IDarPublic
Personally known ❑OR Produced I.D.
Ty )e and number of I.D. produced:
Presislan* N.,l.dLy 43
DID take an oath, or My Commission Expires:
ID NOT take an oath.
NOTARY PUBLIC STATE OF FLORIDA
* * MY COMTISS10N XPIRfS 409/94 *
onded thru Stemb er,Adams & Sweet
�O NOTARY '5;00 TOTAL DUE
* * *
FEES: PERMIT 30•0 RADON C.C.F.
Master Permit # 9
Phone °
75 7 , ?/'7
/
Address % ✓� � /9�'7, Yea- ,q37'/
Competency # Ins.Co.
to Contractor
**
or Owner- Builder
APPROVED: Fire Other
Zoning Building Electrical
Mechanical rumbin
Uering
�JIt UN , • «(v l' Ob' HEALTH
Authority; SITE SEWAGE DISPOSAL I fl AND REHABILITATIVE SERVICES
C hapter t 381. F, S. SYSTEM-CONSTRUCTION
Chapter 1OD -6 PERMIT
A PPlicat , F.A.C. Building Permit
ton 1s for: New
SYst /
Application/Permit #:
Existing System Repair ✓]/ � -3
- ---- - -____ Holding Tank I ] I T ` Tank Experimental System [ ]
Application Received:
OTC; PERMITS __ � ] Other (Specify): ! ] ed. /�
E
Exist em 1 ] catl /Pe
rmit p:
(Temporary) � em
• N
RMITS ctf }) Amount Paid: $
AND HOLDING EX PIRE ONE _
NOT GUARANTEE TANK PERMITS EXPIRE Y R FROM DATE OF IS SUANCE _ Recei b :
Owner / PER FORMANCE FRO DATE A N D ARE N _
FOR A SPECIFIC I PERIOD F. O A PP RENEWABLE. RE
_
Owners p� CIt' RIOD AL 0 PAIR PERMIT DOES
PI: RO V
s Mailing Addr OP TIME. F A SYSTEM
Owners A gent; S /1/67 l S r0 BE COMPLETED BY
l� t'
Agent's Mailing Address:
Property Street Addre
ss:
Exact
Directions to
Lot '- -- ___ Property:
--- ________
# Block q
Se ction :
Subd ivisio n
Towns hip:
n.
Property S ize:
Water Supply: Private ( ]
Is Sanitary Sewer Available;
rs Public Water Available.
Type of
.Estab lishme n t
tane� Ir le s dential
e)
Range
ParCe H:
Square Feet /Acres
Public ( ] Limited
Use
]
Ye 1 ] No No,
Yes l
line approximate the distance
- If No, approximate your the property: to the sewer
-- --- - - -- line
ce
of - set your Property: to the sewer
Units ____
B uilding
# of Pers ons N of Seats
- --- --
rNG sa s
*NT FELANATU MUST F
SURVEY FEATURES REQUIRED
D[ BY
OH S• AND PERT DRAWN TO
FEATURES MUST T BE ATTACH 6 , F' A
RES REQUIRED
nt's Signature:
BUILDING INFORMATION
Bui1
Area (sq ft
& N r B °ms
L'1ng Fixtures; Garbage
Ultra Volume nder /Disp 1
BE ATTACHED lush Toilets Ot Tub
Te lephon e: SH OWING OFFICES, her
(Work)
(Home)
Q(Stat t / .
City:
le phone :(W)
7 0)
City: / : f ,
Stat
� Unit — Date Subdivided
__-_
divided
Zoning Designation:
Flo
°r /Equi Drains
BE DROOMS
E IN ADDITION, BUILDING
OWING PROPERTY ION, A DETAIL Rte' AND ANY
DIM ENSIONS ED SITE PLAN
SUBMITTED PER C
rtAPTER 10D BUILDING
6.046 F.A.C.
Date;
Zip
Ho urs of
O p e ration
Zip:
140 QNSITE SEWAGE DISPOSAL SYS1 EM CONSTRUCTION ANU INS IALL6� I ):
Permit Application Number (V
Notes
Site Plan submitted by
By
Scale: Each block represents 5 feet and 1 Inch — 50 feet.
Pt) c,/ a4/
PART 1I • SITE PLAN
S(ONAIUf E
Plan Approved Not Approved
ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH
HRS -H FORM 4015 -A January 1002 (Obsololes Al Previous Editions) FOR OPTIONAL USE AS AN ATTACHMENT
BUILDING
ELECTRICAL
PLUMBING
ROOFING
MIAMI SHORES VILLAGE. FLORIDA
❑ DATE 195
PERMIT N? 5883 Contractors r
License No.
❑ Work to be performed under this Permit
Owner of
Building c_
Architect
Contractor : 'r
or Builder tr
Legal Lot
Description — Bl
Address of
Building
CONTRACTOR OR BUILDER
Subdi-
vision
Value of
Project
$
Amount of
Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that be assumes responsibility for work
done by his agents, servants or employees.
Signed. BY:
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications subrriitted to the proper authorities of Miami Shores Village. In ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
7
BY AUTHORITY
MIAMI SHORES VILLAGE. FLORIDA
BUILDING ❑
ELECTRICAL ❑ DATE ZA N ' 3
PLUMBING ❑ PERMIT N° 3014
enac No. ca 1
ROOFING ❑
Owner of
Huilding
krchitect
- jontractor
Builder A A
•egal Lot
)ascription
CONTRACTOR OR BUILDER
f _ 1 � C
/ •�
a ddress of C h
wilding
4
195_
Work to be performed under this Permit
//o
B1
ZS r t cc.../4_
Subdi-
vision
Value of
Project $
Amount of &
Permit $ "'
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
ierefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
lrawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
ime if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
!ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
'ertaining to the work covered hereby whether shown on the plans or drawings or in the statements pt specifications and that he assumes responsibility for work
one by his agents, servants or employees.
Signed. u� ( 1 . / BY
INSPECTOR /
In consideration of the issuance to me of this permit I agree to perform the work c hereunder in compliance with all ordinances and regulations
'ertaining thereto and in strict conformity with the plans, drawings, statements •r specifications submitted to the proper authorities of Miami Shores Village. In ac-
epting this permit I assume responsibility for all work done by either, my my .. =nt, servant or employee.
BY AUTHORITY
BUILDING
ELECTRICAL
PLUMBING
Architect
Owner of -i
Building
Contractor
or Builder
Legal Lot
Description
Address of )
Building
This permit is granted to the contractor or ilder named above to construct the building or to install the equipmen or devi e described in the appli-
cation herefor in strict compliance with all ordinances pertaining thereto and w th the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the glans axe =r r nge . 't]iout authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above ass. • fi e, P.hsibility for`a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or . , , e- ications and that he ass ur�es respon-
sibility for work done by his agents, servants or employees. ., {
44ThR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with alllordinances and regitions
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications - submitted to the proper authorities of Miami Shores Village.
. In .accepting this permit I assjj a res nsibility .or all work done by either myself, my agent, servant or-employee. •
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
DATE
PERMIT N° 4943
Signed:
/t
Work to be performed under this Permit "
B Y
Contractor's
Li nse No
By
•
t 194
AUTHORITY