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PAINTJob Address /Z r X J 9c Tax Folio // „to & o % ,of 6a ✓ fad; Owner / Lessee / Tenant 4/(, -� �� Master Permit 1P 53'Y' / Owner's Address /7 (v 9 5a Phone 7 ' S / 7 Contracting Co. - 1 7 Z LvZ, v 7/;:i.... Address c) )(., /..Cc Its � Qualifier ! i( (4-E4 k, SS# - - Phone 9/.- ( f9 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 / 2 5 &. 4 .4 . -a- Cg '!(' v� `o • 71 /j Square Ft. / Estimated Cost(value) Legal Description !- PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 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 4 1 Signature of owner and /or Condo President / ign a ure of Contractor or Owner- Builder Date: Date: ra /q Notary as to Owner and /or Condo President My Commission Expires: /(ota y as to Co y Commission E 1 441:4 % JOSEPHINE 01111111 %Wary PM*. Itila WINO Di ** * * * * * * * * * * * * * * * ** FEES: PERMITJ 7/SU RADON C.C.F. • _5 0 NOTARY .,7 PD TOTAL DUE 4 1 4 g/,049 APPROVED: Fire C�.yOther Zoning Buildin h7 Mechanical Plumbing Engineering 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 Registered Architect and/or Engineer ''QQ Name and address of licensed contractor LG' ��/6-- Location and leel,description of lot to be built on: o j �}/� n / Lot /5 Block Subdivisiorit�.E7 c�lit e4 / J t� ' .7 f� f 0 Z � Street and Number where work is to be done lac? A). / ( 7141 S 7 , State work to be done and purpose of building (by floors), state exterior colors (submit samples) 4J77/VC.— CcDPA-L (-twat LuH/re Lc)©r - '4/0 and for no other purpose. Addition Repairs No. of Stories To be constructed of Kind of foundation Ro f Covering Estimated 'Ibtal cost of improvements $ .7 Amount of Permit S 1 New Building Remodeling APPLICATION FOR BUILDING PERMIT Date `✓ /IS" 19 6 t a L f''^ No. Q f Street Ai. e, 96 3 7 MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT on the site of the work such public notice or notices as are required by the Act. The undersigned a. mploy only such subcgpt=ators. on work to be performed under this permit. as are licensed by Miami Shores Village. Remarks 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 oregoing application, and that he did sign the same. and that all facts therein by him stated are true. Permit No. ' l Date Y Read, Sworn to and Subscribed before me. Disapproved Date (Signed) 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 mad 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 andbr workmanship. N co (Signed) • Notary Public, State of Florida 0 0 0 00 00 Of N