755 NE 97 St (4)PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
r ( OWNER TO RETAIN COPY)
Date/ Job Address 753 y ft d ?7T
Legal Description 11 eti'i 7' - 6 - I 7/2,5".
D" Master Permit
Owner / Lessee / Tenant gOL4/V.2> \/0//,u13
Owner's Address
Contracting Co. j �. ' //J /Ty e9- //2.. C0/1/0/170,43/4 Address
Qualifier v . & Cfi / SS# Phone
State# ,emoo5y6LS
Architect /Engineer Address
Bonding Company Address
Mortgagor Address ����
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING 4lECHANICAI� PAVING FENCE SIGN
WORK DESCRIPTION e 61 /A/(a' pe¢.c, y- ay.
Square Ft.
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.
I authorize the above -named contractor to do the work stated.
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Signature o
Date:
ne
% 5 AM q7 1212=
and /or C• •o President
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Notary i f Owner and /or on Pmatelot es
My Comm ssion Expires: tea �u`Qilic, onda
* * * * 1:iv Comm ion Fxpie uiy 11, 191)
PERMIT FEE: APPROVED: Fire
Zoning Building
�, ��)) Electrical
Mechanical - f ,�' p1Ni Engineering
Tax Folief9// -5206 - /S/
Phone
/ 3 3s5' .S Ca) S 44)6-
Competency # 6C/670Y Ins . Co.
Estimated Cost 9.521
7_,c6-909
re of Contractor
Other
Owner- Builder
Qm f . / /le
Notary as to / Contractor or, Owner-Builder
My Commission Expires :
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MIAMI SHORES VILLAGE, FLA. AIa N 12 4 8
JOB
ADDRESS 7
INSPECTION
INSPECTOR
TIME READY
REMARKS:
Olt
715 DATE
l Li ato work to
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MIAMJ SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
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.
� Date... —..- - _... ...._ P _.._..._...._......_ �........ , 192
Owner's Name and Address (21 I 1 I E fe f p � I U _..j�...�_ /1/42. C _ No Street......
Registered Architect and /or Engineer ,
Name and address of licensed contactor. . .6.C/le...... ...... L!�J / /Q
Location and legal description of lot to be built on:
Lot Block Subdivision..
Street and Number where work is to be done 25......?
done and purpose of building (by floors).....f..i�
/ 2,72..../. j - rk a ?...5'..... .
New Building Remodeling. Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
d
Estimated Total cost of improvements $ L.... .I) Amount of Permit tC 74
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 undcrs
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compil
and has complied with the provisions thereof, and will require similar compliance fr
in the work to be performed under this permit; and will post or cause to be poste
or notices as are required by the Act. The undersigned agrees to employ only su
pennit, as are licensed by Miami Shores Village.
Remarks (Signe
STATE OF FLORIDA,
COUNTY OF DADE. ss
Bcfore 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 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..
"5 7
Disapproved f / Dat
(Signed)
—3c7
Date
ing Inspect
Flaps e
T. - 672 - 3 273
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
[ c)
� _ Z
and for no other purpose.
nd accepts his obligations as an employer
1 Laws of Florida, Permanent Supplement,
actors or sub -con tors employed by him
on on the site of ork such public notice
ctors, on work performed under this
to me well known,
P,L'ANNINC 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 heen obtained from
the Planning Board.
A re-inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.