537 NE 96 St (11)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address FJ 37 Yl - e . I t 4L '* Tax Folio
Legal Description // __ Historically Designated: Yes No A
Owner/Lessee / Tenant wIArcj, v 1 . (00 o-b o Master Permit # j 3 if
Owner's Address 33 7 1°I - e - 110414. 5' f e 4 Phone 151. 11 ' t2
Contracting Co. Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Address
Architect/Engineer
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING GVEEFENCE SIGN
WORK DESCRIPTION Reftace e4t4 vt"e) �tS 04 %LA 1iet,i` sV„, -- ke tocLi4.
yo jer' & rr ek , c.1 A Air vl.� .
Square Ft. IOC) S° ° 44 - Estimated Cost (value) 2,000,
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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 AFF D AVIT: I cert at all the foregoing information is accurate and that all work will be done in compliance with all applicable
la . r- gulating •o tion an . .g ng. Furthermore, I authorize the above -named contractor to do the work stated.
S&2 & tii /01 � � / / -S
Notary as to Owner and/or Condo >preside t Date Notary as to Contractor or Owner- Builder Date
My Commission Expires: - °u r �_` """ ° ""'` My Commission Expires:
s7Y PG � OFFICIAL NOTARY SE F
. Ji ' CO BARBARA ANN FUGAYZ'. i
\ 1i, Si' COMMISSION NUMBER
N gr',�1 : % .g , CC360191
1j. 3C ;• y ° ; COMMISSION EXP.
C.C.F. 1 r NOTARY .' / TOTAL DUE
FEES: PERMIT
APPROVED:
Zoning
Mechanical
RADON
Building
Signature of Contractor or Owner- Builder Date
Electrical
Plumbing Engineering
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CLOSETS
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LAUNDRY URINALS
CATCH
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Permit No..
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR " PERMIT
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 work.
Owner's Name and Address _____ ._'...__._...._� �.._._..�.
. _--_.. No. _. _— .__..— ._____ Street
Registered Architect and /or Engineer---- __--- - - - �_� - __.
Ern !oyingl es Name
Location and Legal Description Lot
Block
Street and Number where work is to be performed —No � `%'
State work to be performe8 and purpose of building (By Floors) ________ _
New Building__ - - -_ _ -- ....... ......._._ Remodeling_ __._..._.___ __ Addition - - - -_ .
No.. — Street
Repairs No. of Stories
Size Septic Tank __--- _• - - - - -- _ _...Type of Tank —_
Feet of Drain ..... __-_______Dist Feet of Tank or Drain Field from Well .- •--- .......__._.._
Nature of Water Supply: City — Well.___ _ ______.__ __.._— ._._...__. —__. Size of Soakage Pit
Capacity Gals
Date.
`'-
Subdivision. -_._____-.________.
Street
Amount of Permit $ if ( Signed)- "-- ___ -�' _ '� Ins ctor.
pe
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 5968, Compiled General Laws of Florida Pennanent Supplement, and has com-
plied 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 sub- contractors, on work to be performed under this permit, as are
Boomed by Miami Shores Village.
( Signed ).._ /
STATE OF FLORIDA, ��`
a.
COUNTY OF DADE. f
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acicnowledgments, 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.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and/or workmanship.