PAINTBUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of r
Building
❑ PERMIT N? 6494
MIAMI SHORES VILLAGE. FLORIDA
Lot
CONTRACTOR OR BUILDER
Bl.
Signed
Work to be performed under this Permit
Subdi-
vision
BY
Value of
Project $
DATE .. 195
Contractor's -�
License No.
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 Pe e 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 Condit' n upon which this permit is
granted is the understanding that the contractor or builder named above assumes th responsibility for a thorough know�)Adge of ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or iji the statemgytl�3`or specifications pnd that he assus responsibility for work
done by his agents, servants or employees. f J J' `.
BY:
Amount of
Permit $
In consideration of the issuance to me of this permit I agree to perform the work covered hereundn compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted the proper authorities of Miami Shores Village. In ac-
cepting this permit I a ume responsibility for all work done by either, myself, my agent, servant or ployee.
AUTHORITY
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 Address. - - ''
0
( Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Building Inspector
Registered Architect and /or Engineer.....
Name and address of licensed contractor ` A s.• . ;::
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done
State worlt,to b ne and purpose of.uilding (by floors)......,
G
New Building Remodeling Addition Repairs `� No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ -. - _,. / 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 pennit 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,
pleent,
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 subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
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
and who, being by me first duly sworn, upon oath deposes and says that he
of the above described construction, that he has carefully read the foregoing
therein by him statsdd are Pue.
Permit No � � Date ■,
Disapproved ggte
is the.
application, and that he did sign the same, and that all facts
, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
Date
No
r
Street
and for no other purpose.
to me well known,
PLANNING BQARD 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 hecn 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.
Date
FEES: PERMIT RADON
PERMIT APPLICATION FOR MIAMI SHORT
Q� X Job Address c 57" Tax Folio
Legal Description Historically Designated: Ye:
Master PI
A Owner's Address c `� S ° l��r 5' j Phone
Contracting Co. Ov•- r (L Address
Qualifier SS#
State # Municipal # Competency #
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
kWORK DESCRIPTION �IN —rn, i T OIL- ►C /4 S ` R1 P De=b A co[t)
6 AP-A 0000- w PQE SS U( E CI- EA t� �c
Square Ft Estimated Cost (value), &�
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 authorize the above -named contractor to do the work stated.
- Owner/Lessee / Tenant M - 1.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
APPROVED:
Zoning Building
Mechanical Plumbing
C.C.F.
Si ature of ontractor ro Owner- Builder
'Notary as to Contractor or Owner - Builder
RY PU OFFICIAL NOTARY SEAL
�P e l, SANDRA M MONTIEJ
2 r * COMMISSION NUMBER
< CC40126
9 '`~ 4 o MY COMMISSION •EXI3.
' o prO 41,19 _
NOTARY
Electrical
BOND
TOTAL DUE
Date
Date
Engineering