916 NE 96 St (11)Owner's Name and Address (1}'h' F ' ZO r? l u
MIAMI 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 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 the work.
Date
No.9 /�
Registered Architect and Engineer
Name and address of licensed contractor CiE ( "rt r�L C13% 1 f j n_( ! < .7/ i' Tv f ( ‘; d kl //i/ j ,�� '" 9 ('
Location and lega) of lot to be buil on l / L
Lot path/ 9 Block 7 Subdivision Alba' ba' ! / 1;'6 / 1
E' �'
Street and Number where work is to be done 1 (c, (�. ! A /
�� ✓+
State work to be done and purpose of building (by floors), state exterior colors (submit samples) 4- C /41 "s i C' ` 5 r F.-eV Cti 0 '4' /C'- ', V f r
1- PO g (i ,s l_ , - LA (0,0.r SE�/Z'
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation I Roof Covering
Estimated Total cost of improvements S 6 U Amount of Permit S \�
Plan Cubage
Zone cubage required
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all 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 obligatons as an employer of Labor under the Florida Workmen'
Compensation Act, being Section 5966, Compiled General Laws of Florida. Permanent Supplement, and has complied with the provisions thereof. a ill 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 se to bjp sted for inspection
on the site of the work such public notice or notices as are required by the Act. The undersigned ag to employ only such subcoi tors. n rk to be performed
under this permit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA
COUNTY OF DADE. } ss.
Before me, the undersigned authority. a notary public, duly authorized to administer oaths and take acknowledgments. 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 fore oing application, and that he did sign the same. and that all facts therein by him stated are true.
Permit No. l kv O, Date • / e e Read, Sworn to and Subscribed before me.
Disapproved QI / Date
(Signed) o li>�f�'��/
PLANNING BOARD DATE
�( 0 r/
i� / 19 l� �i
Street e !�t/
Notary Public, State of Florida
Building Inspector My Commission Expires
Chairman Member -
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of $25.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board.
A re- inspection fee of $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and■or workmanship.
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
Registered Architect and /or Engineer
Name and address of licensed contractdr «t L'
Location and legal description of lot to be built:
Lot_________ Block Subdivision
Street and Number where work is to be done_ _ /___(a -
State work to be done and purpose of building (by floors ).rl4i�� _L! : �cr_- _____f 14-
-1Yl it�St!a1�tp_„ 1!ic L� L = 1 " = - ---
and for no other purpose.
be sent
Chairman
Member
Member -- -- ---- ---- - --
APPLICATION FOR BUILDING PERMIT
MIA I I SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Date
Date__
-
i
Distance to next nearest building
Date__��!t 4�
� No X C' Street
New -Bui d ng 2 A4,1.2 ( _ - -_ Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation g
Estimated Total cost of improvements $ /� /.- 5.--P--13— Amount of Permit $
Zone cubage require ___Plan Cubage
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 end its construction may
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�'`i1_.,r-- -",v1, _ �? `i / °l fit s
The undersigned applicant for this buiI$ing permit does hereby ce:Fti 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,
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. ss •
Before me, the undersigned author, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap
peared �'l; =r -:e
- - - - -- 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,
therein by him stated are e.
Permit No ®� _
Disapproved
(Signed) _
r -a�,( --
Read, Sworn to
and Subscribed before :me.
Notary Public, State of Florida
Building Inspector ; v My Commission Expires
Roof Covering
that he did sign the same, and that all facts
PLA NG BOARD DATE
Member
Member
Member
L ,19
0 Y •
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 been obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improi c_ t ,th c for inspection or faulty
materials and /or workmanship.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date ) Job Address Tax Folio
Legal Description Historically Designated: Yes y
Owner/bessee / t. ,6 G VS 0". Master Permit # __ 9� ,) � / 33 912
Owner's Address q 1 b �A s r' /1 / P Phone y�
Contracting Co. 2?b Ar-- ,4 / S6) c.( � / 7 "<— Address � 7 .7 /V / S'? j 7 /vc - f1 / 1i o t t; O
�'
Qualifier R77 Y 7 PgR/ SS# Phonc 7 E /� 22.. — Y /O0
State #e_ / W/o
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING 1VIECHANICAL ROOFING
WORK DESCRIPTION i✓S 7 GE / ,r 7
Ai(t%' c.- P'zc/oRis //S f 4s_i / Z
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.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMI
Municipal # Competency # Ins. Co.
Address
Address
RADON
tary as to Co
My Commission E
C.C.F. CYylenn NOTARY
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Reipf
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• fires:
PAVING
BOND
No
FENCE SIGN
ature o ontract r • *- Builder Date
OOP
2
as Date
TOTAL DUE
APPROVED:
Zoning Building Electrical
Mechanical Plumbing Engineering
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2) P /2 0il(S z
9I6 N.(96 ST t j 4 1 ?e ' 33 /jj