PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Dated _ Cr Job Address /0265 Ale" `19 5 Tax Folio
Legal Description Historically Designated: Yes No
Owner/L essee / Tenant 4te it IU S G h 4 a p'
Owner's Address /07 5 /(f g. 9Q S 4 •
Contracting Co.
/.0-6. h r G ovi
Qualifier / /G % G 4/ tt)
State # ( a ?t6 r / Municipal # _
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE
WORK DESCRIPTION* PpessuiL ie.el"i()/ey S G
o, L_ .
-151)-1- m i �.. ,�.e., fboon &- - /A PuRC
c�
Square Ft. Estimated Cost (value) ' A O
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.)
No
My
FEES: PERMIT 19
iBilfAvj L � , � ,, �� q
NO. OC.�
1 oo:0* maim 11 owl.
RADON
APPROVED:
Zoning
Mechanical Plumbing
Building
Date:
Address
Phone 3®" 1"1a/5 5 7
Competency #
Address
Address
Master Permit # 8
30s- 767 -I?7s'
.lD,/ 72
Phone
1 /A
SIGN
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 , :onstruction in this jurisdiction. I understand that separate permits are required for ELECTRICAL
PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNERS 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. F ore, I authorize the above -named contractor to do the work stated.
/ // � �
a . , e of own .. d/or Condo ' Date
'Signature of Contractor or Owner- Builder
Notary as to Contra
My Commissi
Ft)
C.C.F. ; NOTARY
n cm
•
r or
E X�npii OFFICIAL NOTARY SEAL
pu��e 9 MARGARITA MONTIEL
"(��k COMh4S90N NUMBER
N ' a CC797277.
- v j . � �� NIY COMpfISSION EXPIRES
` OFF .° DEC. 17,2002
Electrical
Date
Date
r
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 1 C( 1 F/ W
Registered Architect and/or Engineer
L me and address of licensed contractor
Location and �legg11 description of lot to be built on: Q �,,�
- � C-� : C —Cr Lot /3 W o� ) q Block / St bdivision gM fi' �l /, .r,,,,c �. woe 7
i. Street and Number where work is to be done / '- ? ? ! e
v State work to be done and purpose of building (by floors), stare exterior colors (submit samples)
/ ,gxT R /0 , Guff-l7
and for no other purpose.
New Building Remodeling
To be constructed of Kind, of foundation Roof Covering
+Estimated Total cost of improvements S ` Amount of Permit S ✓ . , STO
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 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'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 rbcontractors. on work to be performed
under this permit, as are licensed by Miami Shores Village.
Remarks (Signed) 4/411r, ; / /// .' A∎ ∎- _; / / '
1 /
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 constry tion, that he has carefully read the fore going application. and that he did sign the same. and that all facts therein by him stated are true.
fr
APPLICATION FOR BUILDING PERMIT
Date
Addition
Permit No.
Disapproved �/ `� {� Date
Signed) �\���► il
Building Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
19�
No. iO'a s Street 170 0 f / 9K
Repairs No. of Stories
Read. Sworn to and Subscribed before me.
Notary Public. State of Florida
My Commission Expires
PLANNING BOARD DATE
airman Member
nber Member
fiber Member
cil Approved Date Disapproved Date
''E: 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.
- 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.