1138 NE 99 St (5)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date — Job Address /I ?i B E. 4 q S I . Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant / it 0 nA 4, kr re Master Permit # 3 g 5 - 7
Owner's Address 11,32 Phone , C3. O S) 7 S 1- 55 7`
Contracting Co. Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION P,s \L/Li tit" . C 9 h ' - 1 OAnA �l in c h _
Ohl 747Jt7, _
Square Ft. Estimated Cost (value) 94 . 00
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 ..rk stated.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
APPROVED:
Zoning Building
Mechanical
Sign - of Con actor • • er- Builder /Date
Sign 0 d L 7 793
N
y Co
Electrical
FEES: PERMIT RADON C.C.F. G 0 NOTARY J BOND
Date
Plumbing Engineering
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.
Owner's Name and Address ✓ /V/ 4/V No.//3& Street' ??St S /
Registered Architect andior Engineer pp ,� 1
Name and address of licensed contractor 6o ,6E6 T Lw COIT S a r
Location and legal des ption of lot to be built on:
Lot -5 Block f 7 7 Subdivision — 745 / ( // f 1 S /c/ 'Mir '0
Street and Number where work is to be done //I /LIE Fr c5:/
State work to be done and purpose of building Iby floors). state exterior colors (submit samples) p qE 5 Vet (L 4N + ! Y9/N r
/Toot (J,)TE AVP jAf/✓r ,xrER1oR of )ovsi'
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Rooff Covering
a Q S7"&
Estimated lbtal cost of improvements S 4000 Amount of Permit S
Zone cubage required Plan Cubage
Distance to next nearest building f Building Lot
Maximum live load to be borne by each floor
I hereby submit all plans and specification
Atelier Tan A SW2170
The undersigned applicant for this building perrECOVIJWIteemmu and accepts his obligatons as an employer of Labor under the Florida Workmen's
Compensation Act, being Section 5966, Compiled General Laws of Florida. Permanent and has complied with the provisions thereof. and will require similar
compliance from all contractors or subcontractors 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 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 foregoing .plication, and that he did sign the same, and that all facts therein by him stated are true.
Permit No. 5 O �l6 / Date / ct V Read. Sworn to and Subscribed before me.
::::
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Date `Jf91 C 19 7/
e to the building and its construction may be sent to
Notary Public. State of Florida
Building Inspector My Commission Expires
PLANNING BOARD DATE
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 andior workmanship.