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CONCRETE PATIOPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Da Job Address 1, n &) Fi 19 . Tax Folio Legal Description Historically Designated: Yes No it Owner/Lessee / Tenant vs AM Acie.ie Y Owner's Address t t Iq V E en (2. . Contractin Co. f Qco (oN S QuC.o J {CQP. Qualifier 1AG TOLEC SS# Phone t;) i7 -6507 State # CerC Q.<5 g 6$ Municipal # Competency # Ins. Co.' (L1IF[ h FeG4 LS Address Architect/Engineer Bonding Company Address Mortgagor Address Permit Type (circle one): 41TILDING)ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIP'T'ION 6v'11 C ?Al' 10 Square Ft. 35�v gn 3 / 2 0 / e of owner and/or resident a te �., d-q ► 0- 416.,,1 1r1_0 1 Ate. 'I • 2 , ondo President OFFICIAL ROTARY SEAL ANGELA M BECKER ! * COMPASSION NUMBER • CC786697 ((‘ OF FLO MY COMMISSION EXPIRES NOV. 1S,2002 otary as o 0 My Commission FEES: PERMIT APPROVED: Zoning ae RADON 1 1,/0 Building ate Mechanical Plumbing Address Master Permit # ‘7 gq Phone 131 ST (Z . Estimated Cost (value) t C . 0 0 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. otary as ,. Contra.. or o Owner - Builder My Commission ExpireE C.C.F. I &' Z.) NOTARY c,0 OFFICIAL NOTARY SEAL ANGELA M BECKER COMMISSION NUMBER CC786697 MY COMMISSION EXPIRES NOV. 15,2002 BOND 3 00 TOTAL DUE 3 6 Electrical Engineering s STATE OF FLORIDA ) ) SS. COUNTY OF MIAMI DADE ) STATE OF FLORIDA ) ) SS. COUNTY OF MIAMI DADE ) (ACKNOWLEDGEMENT-INDIVIDUAL) The foregoing instrument was acknowledged before me on by , who is personally known to me or who has produced as identification and who did (did not) take an oath. Signature of Acknowledger: Name of Acknowledger: (Typed, Printed, or Stamped) Title or Rank: Serial No.(if any): (ACKNOWLEDGEMENT - CORPORATION) The foregoing instrument was acknowledged before me on by , of a corporation, on behalf of the corporation. He/She is is personally known to me or has produced as identification and did (did not) take an oath. Signature of Acknowledger: Name of Acknowledger: (Typed, Printed, or Stamped) Title or Rank: Serial No.(if any): `'r S. STATE OF FLORIDA) COUNTY OF DADE) a,50/40,k/ (property owner) Lk* N uCS Gua etGkaa. , ti .0 (name of surveyor's company) performed on ©q p 1 II °I , is an accurate representation of the existing conditions and I � ( to of survey) The undersigned Affiant, attached survey, performed by locations of all structures on the property as of this date. AFFIDAVIT The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than six (6) months old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits.. Further, Affiant sayeth naught. sign and print) Fl C1rL �► TCf{HA� SWORN TO AND SUBSCRIBED before me this (4f day of , does hereby attest that the Affian operty owner Witness(sign and print) Affiant is personally known to me, produced a 0 7ga g-?7o as identification. on. // ARY SF • NOTARY PUBLIC STATE OF FL OP.IDA C0mNf1SS1ON NO. CC7L4l MY COMMISSION EXP. MAR.1 002 ary f OM Ar 40ktre gig SLAS 'This property described as: Lot 16, Block 178 REVISED PLAT OF TRACTS 178B, 178C, 179A, 179B, 179C, 180A and the North 1/2 of 180C, of REVISED PLAT OF MIAMI SHORES, SECTION 8, according to the Plat thereof, as recorded in Plat Book 43, Page 69 of the Public Records of Dade County, Florida. 9 ',45,0A // ,dc LEy (p R V 7s. 00 •Q.1( • 1.0 01- • 0,95 CL. 9 4 • w/re 0„ GTYP) •� Il o 10.0 n.C.25 _•>>s_ _ N /3.99' 10.75• tn N 10.90' 24.5o• Nnl ILIM 1111 onto 11111 SIGMA MM. Ann 1111: 11 M1 1 :INA1 :M41.SI:0 %I.A1.111 1111111Pa 1.u'1:NS1:11 SUM 1:1'Inl ANTI 31 tin 0 IJ • 0 75, o0 A BOUNDARY sultvcr 1 hr.r). ..rod* duo the I,I.vr, .ep.e- 1enled hereon meets the technical 1landatd1 let tooth 14 the loud of land Swreras in chaplet 1IG17•11 Honda Admini/uative Code punuans a. Section 472.017. 11a. S•111111. lime ate no encroachments. ovrsIapl, siemens% appea.ini she Mal, .u■rt than at •hnwn env .. ZZ woo • • /2.BS u 15.Go' 39 _„ 0 t� 2 3, S ' - L 9 9 �h Y 2 2 5 A /7 /°�:,1.∎ -7cr, v PROPERTY OF: Ackley Susan D., 1119 N.E. 99th Street, Miami / 1.5. 9s e1. POW. SUMP* VORAPI •peen PM L�uJG *7724 ft 57U 1•4•10PS. aQ C N. o; N 0,50 " CL, DATE Page 1 of 2 Low a >: /or i2/ter, / c aari) 1.03=a4on a 4he el vat,, 141 - 61A may{' 1 TANK a eAeALL .. Pd 4 Govcve c. r w►I>� fro/6)(6, L 1/ - M Note: Garage Elev- E.R.P. 74(2- , �, lN � ib 2t1 3/ Shores, Florida 33138 LANNMS AND (:ARCIA, INC. H 2111)X tit '.YOBS- 111A1','1 ?Itti- 1.AN11 1'I.ANNI. :fls ERNESTO E. ESPINOSA 12946 • Oilier odd. ell:.E 9 Alcvar Avenue, ('oral (:.plea, 1•1,c1411a .1.11.1.1 0 E66 -7'1119 ('15.11 51.1 N/.6.1 s , i h. DRAWN 11Y 1115'( :. NI1 a Oa •- 108118 L.F. Elev- 6 5S denotes lower habitable floor elevation. Elevations shown refer to N.G.V.D. 1929. Lowest adjacent grade elev 79 __ t3m # il30s Elev 7•00 ~ - I LS11.1 oP.UL►A1llLA fl Y1AT11#81 A • Arc Ihalence NC • A.. Co thtionmg fart C) • Calculated CO. • Cdch Ilsaln CI r. Cleat CA. r Cr..Irr I toe Ent: • Encroachment 1 1 P • Electronic henslormer r of' • Found Ion Pips r I It * round lion 11d Oil • Ovelhanit U 11 H. • 0111r.s1 Records hooks 1 • Plsl Hook P C • I'olnl oI Curvature PA • Novelly lino P U n. • Pohil d oeebmine U P • Utility Pole W M • Witter Meter No tes u) All Clearances and/or encroachments shown hereon are of apparent nallire.Fenre ownership by visual means. Legal ownership of fences not determined. 10 The issue of this survey is only for the eulusi'e and specific use of those persons, parties or institutions shown in the certification. Any other intended use will require tt liltl'II approval from the certifying surveyor or firm. c) Code restrictions and title search are not reflected on this survey. d) Underground u and encroachments if sine, nut located. el The hood inforn►alion shown hereon dues o imply Thal use referenced properly still or will nol In free from flooding or damage and dots not create liability on the pall of use lirm any uflicrr or employee thereof, for any damage that results from reliance on said information. I) The ha depicted hereon w ere surveyed per the legal description and no claims as to ownership or mailers of Ii11r are made or implied. FLOOD 'ZONE: AE FLOOD IN FORM A'1'lON: Community number: 120652 Panel number: 93 Suffix: It.I.R.M. Dale: Ruse Elevation: Hearings, if any shown loused toot -- _ CERTIFIED 'M Rapid Ttile Services Company; Attorneys' Ackley, Susan D., PROPERTY OF: III: II r Ihnwald l',mole nrrnrdt I It .r. • Ctmcreln Shuck Shtu:hua 1:11111' . 1'tmrf r•In Pod III r I 1 M - Mr...mord (1 I11 - (Motored MUM) t Inas - road of S ,,,n hung) Cuivn P 111' 1'o .4 4 ,mnnlrot soreul .5 * (. enhet Mhulo J 3 -02 -94 +8.00 N.G.V.D. ck Susan D. 1119 N.E. 99th . t'R % 1 Y I herein rend) that she wove. rrprr- tenled hereon Meets the technical slandards set lurth hl the linaid of land Surveynrt an ehaplei 4.IC17.4 Ilolida Administrative Code pursuant to Section 02.017. Ina. Stamm. Mere air no encroachmrnw. overlent. easement. appraiiinci ahe Mat. other Shan as •hewn he o _. Ill 1•■ = Maturing 1 :11 = Chord Iaslance Itn •rI halftime. Easement I II r. he Ityd•nd N I: V I/ r ttallosl C eod.tic Vuecal lta I' • flat I'll r Page P 11 C • Pulse nl Ilevem. l :urvehlu (reference) Page 2of2 n • MMus IlAtl • Iladial 111W • Muhl 01 Weir Sri: • Sacilos SCII ...Screened 511 It lion SWK • Sb1.wsik It F. 111Niiy E.sununt Title Insurance Fund, Inc. a Street, Miami Shores, Florida 3.3138 I.ANNI' :S ANI) (:Att('IA, 1,.11. II 21198 SIiltV1 ':YOl(S- MAPPERS- I,ANI) I'I.ANNI' :ns ERNESTO E. ESPINOSA #2946 FIELD I DA'1 :' SCA i l I/llicr mistress: 359 Atrium Avenue. (•eral fiehlre. Hut 1.111S) 666 - 7109 l'15.11 62.1 -566.1 I DRAWN BY I DIM:. NO e•C• tbi /n. 1 .4. t2 C, C C h ;-11 j7A '6 e'Q v /cJ /5 zpon tic2ilet6•P5 r.LL 7 1 Lo7 Lit 4= 4" to.'•6 ; 40' • 014C. C S E i 0 1 ._ 5