857 NE 97 St (10)-�� -7 37
-,
WORK DESCRIPTION
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 941 Job Address ‹� 7 / /( - 9 7 S 7- Tax Folio I ffi) IQ ! 1-0-0
Legal Description l- I i tl 0 714 g ,,�9�'
(Owne / Lessee
(Owner
Address / Are/ e / f T" Phone /767:-/r- `7s'
Contracting Co. --Ay - ( (1 4/ , dress /O7/3 5 ri
Qualifier ,P,..64-/g% /(1 Phone r 3 S 5 % -S
State it...X:149 Municipal #L 6 779 5gCompetency # Ins.Co.6;-6,A3 �kc _iDie,v
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING HAN GOOFING PAVING PENCE SIGN
/ Tenant / e-i-K/ hl e-T
0 t t-(-e c T
Square Ft. Estimated Cost(value) - 5 1 V
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.
Signature of owner and /or Condo President
Date:
tary as to Own and /or k ittith
y Commission Expires: ig ar w wero2
erne OF FLORID
A1Y * K 19 1
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Mechanical \N
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FEES: PERMIT 6 / / -. RADON C.C.F.
APPROVED: Fire
Zoning Building
Plumbing_
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Not y as to
My Commissio
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NOTARY
*
Master
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5 op
Permit #
gnat re of,qpntract or Owner- Builder
Date' /L9'
- — 01.14,51M21291M11111111111 • td 4 ot iii 2u nSglQ -0 1P1.4kier
y ommissan Exp. Apr! 30. 1
o 3` No CC197545
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Other
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Engineering
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TOTAL DUE i(���
NOTICE OF COMMENCEMENT
PERMIT NO. TAX FOLIO NO. 1/ - °2194 /( A-0
STATE OF FLORIDA:
COUNTY OF DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. egaa d pr pe and address: t L 6yA f
f
77`
2. Description of improvement: LA G I N l0-( 1- A/C A/ 2 /IA AI h
3. Owner(s) name and address: !%� Ad �- EGA Dl4141 S
1? 7 N t✓ 9 7 $ r , A-wn , S't- En,e. --S i C 3 3/ 3
Interest in property: (DvJ /1/43-e)
Name and address of fee simple titleholder: " -Pr L'/')
4. Contractor's name and address: Tv j - 7?A y C ( P' a F G
ID S ct,J i vo
5. Surety:(Payment bond required by owner from contractor, if any)
Name and address: 1J /4
Amount of bond $
6. Lender's name and address: N /p,
7. Persons within the State of Florida designated by Owner upon who no
m t ces,gr,other documents may be served as provided
by Section 713.13(1)(a)7., Florida Statutes.
Name and address: /■ A
8. In addition to himself „Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in
Section 713.13(1)(b), Florida Statutes.
Name and address: - /i /Q
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless
different date is specified) i.1?■ ( (�-/ 9 xp 7
Signature of Owner ,,//
Print Owners Name Ken)N i (1- l -A Yn S
Sworn to and subscribed before me this c9.1 day of
Notary Public
Print Not- s - me
My Commission Expires:
LES
E A: KINDER
STATE OF FLOR DA
MY COMMISSION FXPIRES
29 MARCH 1997
Avg , 13J
p. , 19_13.
93R4-6600 1. 1993 SEP 22 10 :29
' 5 7
Dime Or t LORi9A COUNTY Or DADE
I HEREBY CERriPy i'; this is a Into co ., of Oho
o ig;nal Clod inyf,ss n d y /
II G j
W rMEcS n•• h .� - -d Of f:i::i so I.
Prepared by: 2E
/,,J
Address: /(-)
_1211
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VYL.T=soc,A
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Owner's Name and Address Ri e HARO eo /yq N '7'
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Permit No
Disapproved
(Signed)
e
Building Ins for
Vyi10AMO Sl !•RES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATO` ■'N FOR BUILDING PERMOT
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. .s3. //
No.. J�._.7 /y E Street
Registered Architect and /or Engineer
and address of licensed contractor tic L . _-1-) Pr T/ o'iY / nt
�Locatio and legal description of lot to be built on:
Lot Block 73 Subdivision i
l l / fa NJ.L..._s Q_�i` _._ e •
Street and Number where work is to be done 2,,c 7 ^ °.r'_
State work to be done and purpose of building (by floors) 1 H ,S. L• Z— 3 T 2/ o e9 N,, r z t9 Pi tea.
cA.._. 11547 Le5/v r76t )
and for no other purpose.
New Building Remodeling Addition Repairs' No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ 3.p e' 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 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 5966, Compiled General Laws of Florida, Pennanent 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 subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village. �0 I /�
Remarks _ (Signed) �"��t! ✓°�'°`i�7z✓ Jt
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 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.
Date 1 ~ 71
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
ANNING BOARD DATE
Chairman ,/ Member
Member Member
Member Member
Council Approved Date Disapproved
,19.7 f
to me well known,
Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval
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.
has been obtained from