PATIO/DRIVEWAYPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date ) 3 1 — y / Job Address �„2 � /v . Tax Folio
Legal Description
Own / Tenant
Historically Designated: Yes
Address
Master Permit # go9'//
No .,c(
Owner's Address 1 s,__Q? d g r �(� /' ('S Phone 3 O� �(�
Contracting Co.
Queer SS# Phone
State # A 1 Municipal # Competency # Ins. Co.
Architect/Engineer , 0 /} ) J J Address
Bonding Company /
Mortgagor A)/ Address
Permit Type (circle one BUILDIN ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 7Q1- a.
Square Ft.
l Estimated Cost (value) • # 4 t° 0 m 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.)
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: PERMIT 14"61 RADON
C.C.F.
Address
c gs.,,u c 3
Signature o ontractor or Owner - Builder Date
Notary as to Contractor or Owner - Builder
My Pm� �t. "iaci As.r
li SAZUWA M !.EoNT.IEL
i * COPJid.SSSIOa'
• CCi.O1 1
;F t.\Q
MV V cOMNI1r.• zi EXp'.
NOTARY
Date
2 - 3- '7
BOND y�
TOTAL DUE ` / t ` 6 e v
APPROVED:
Zoning Building V 1 /`✓ `7 Electrical
Mechanical Plumbing Engineering
•
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LOT: I
FCR: O L r� t: � .arz {G JO8 No.: q /O - .
PROP. ADD. ;LR?) G gPyTK Q , (�fAt lt i � II• , r F. BOOK: AVL
LOCATION SKETCH
SCALE: I" _ (40 DATE FIELD SURVEY:
LEGAL DESCRIPTION:
P.BOOK: 4 3
BLOCK: SUBDIVISION: ' 1 kag ±1..oQ G�
PAGE: EO Gei
11
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CERT IFIED TO: o4E4. IA eVi212 c, ura A e, i �r�1oDar o 0Egt.c.-
'Si tk. rth a 9S� aricrop eioe2 ‘Gpsf►,
19P-U -r Nferio fowl. ' cited ! �� rJ�1�f p '�'Ct GoMpo.lJ
SNR- SIDl:NAI.R, CRS- C,oscR TZ FLOC= STRUCTURE, CLTsCRais LINN micas. r PROPERTY LIlm, II/ DANA &
DISC., IP -IRON PIPE, F- FOVI(D, STt- STORT, A/ CAA= coND /TIOKING PAD, P /C =PROPT,1eTZ CORNER, D/3 ■DILILLED
MOLE, w /Pwt1OODEft PENCE, RES =RLSIDEIICL, MACLEAN, RI!- RL811R, DVAUTILITS EASD T, CONCmaiNclorEs ELMS,
R /w =RZC!T Or WAY, c /L=CE71TIOILZRE, O■'DZAMETER, SP =SP IRE, TTP =TED ICAL, MANEARENISD, R=Rr.WRDED,
ENCR=EtlC ROACIMENT, CO)O'- CONPVTED, Ci IICIFT NAXL, A/N -ROUXD NAIL, Ste, PPZ =rxxxsi FLOOR LI.ZPATIOW,
o /s'.orr 3!T, P/P POWER POLE.
SURYVY0W51107101
I) Tiff SWIM OF T1S PROPERTY !Nowt? NERSON IS IN ACCORDANCE MRT N TEE DOCRS111014 FORMS= sr 416tar puNLE3! A Cosa•ARtson IS
stiOWN. ALL IWARfNCS ANGLES. Aso D[ITMIC=! UMW ARE 11IE tom AS PLAT rALUEl.>7TRE LARDS soown HEREON MERE NOT AkT1hACTm root
EAsRmo VTS cm aISSOe smou sRARCE3ACIf =form «1 Tlffi PLAT AND THE MJ? ANY MAT IR 010WN ON Till! MPIETCSNRUNDEROROUND
Tarnow, OI MO :NM NOUNDATIONS OR Or= IMPROVONDOT smut nay LocATEDISHINCS MRS ANEW TES CZYTERLINE OFTl111 MA E aWALL
TO TILEMEOWTEELUOS eNL: LBTATTON D'. 3V MOWNARIBAs= oN LNATIA1g4GVD►IMMZO =wisENonsD rmERE
ARL MO MOTE GROUND [NCROACIDONT1 MUM WAR THOSE =HOWI OTIUs iNRVEY is !OR MOST AGLL FURPOIDX ONLT. NOT TO PE WED FOR
coNSTRUCTIUN PVP.IOeiES.
[ RENEl<Y CERIUM TTIAT TTE ATTACICED sISTCA or BOUNDARY BURY= OF TIM ^ri mm oracTUs}y MIOMCRTY IS A TR
of A FLF1D ARMY VFY MADE: UNDER MY DIRECTION AND ? Th MD[DNUM ILCTIMCAI, STANDARD! AS ATM i' Y
LAND SURYCYOR! Lr1 CIUM'TER IUDL4 FLORIDA ADIRN STRAT1VE P $*WVANTTO =tap fIJ.CI.
7996 WEST 18TH COURT PHONE: (305) 823 -2904
HIALEAH, FL. 33014 FAX: (305) 827 -1632
NOT VALID INLESS SEALED wXTH AN EmB03SED SmtvEYOR'S SEAL
- .z , _ 111
COUNTY, FLORID;
AND CORRELTREIVESIENTAL1ON
w BOARD OF FROSTS:NONAA,
IIARK K. KRAJNIX
REGISTERED LAND SURVEYOR 13371
STATE OF FLORIDA
1
REVISIONS:
COIN.
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rte.
'95
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FEB -1� -1 b 15:4d
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SKETCH OF BOUNDARY SURVEY
SCALE: 1" =?o
2r re-4-o,1 -r, 6Mr
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A - 57 40
' rte Z4 •84'
G :35• z4
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of ►fl � . ',.
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TOTAL P.03
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ROYAL- LA- BARRE- E RUTH- LA -BARRE
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91`;1 NF- 9E)TH -STF T- FL-33133
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10:31
MSU
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
'rate I ( Job Address /42 91 WE firl% To Folio
ega1 Di iption Historically Designated: Ycs No ^ .✓
loon hoocc / Tenant P,• 1 a �t*3.9ir,� a Master Permit # 3 �vZ
lamest': Add ew / . 9i
:attracting Co L_ 6'tL -+.�- . Address /,o0.1' .oXr
Neither ._LYrAkcsSigrs�
• ;taio t, . e G e 0.2_47/7 Municipal M Competency N Ins. CO.
V hited/Enginxr "_ ' Address
'audios Company
Address
AMPS** Addrete
'molt Type (clerk ono): BU•ILDiNG ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SION
l'O1tX DZSCRIPTiON
;gore Ft 70_a
D
)1gparure downer and/or Condo President 1)atc
Votary u to Owner and/or Condo President bate
!Ay Cominissiao Expirci:
1.t,ES: PERMIT -ia RATX)N C.C.F.
APPROVED:
Uuilding
Udall
Plumbing
Mechanics'
i
M- Corntnissiun E q ices:
q)f.)0T
�_ Ekx:trical
Estimated Cost (value) 9,,y, .
001
a'ecotereo /i
NARNINC TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR itAILURE TO DO t30 MAY
OESULT iN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
^ONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
triplication is hereby made to obtain a permit to do work and installation as indicated above, and on the auacbcd addendum (if applicable). I
:ertify that all work will be performed to matt the standards of all laws regulating construction in this jurisdiction. l understand that separate
termitic are required for ELECTRICAL, PLUMBING, SIGNS. POOLS, ROOFING and MECI IANiCAI. WORK,
)WNER'S AFFIDAVIT: 1 certiA that all the tbregosng information it accurate and that all work will to done in compliance with all applicable
aws regulating construction and zoning..Furthcrmore, l authorize the above -n: r rcl contieetor to • the work s
,tture of Contractor to Owner- Builder Dar
a., to Contractor or Os nee -Boil
•' FICIAL . OTAR S
BRIGGS
NOTARY PUBLIC SI ATE vi' FLORIDA
OOIIfMISSIOh NO CC194206
• • id15SiON 3XP. An ii 1996
Engineering
L C1
NOTARY L 1'OTA1. DUE
•
FEB -15 -1996 15:48
/2440'
o '; /I .
(� 0 9
N H q• . 1k c .
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=7,e7zte:-.1 e
SKETCH OF BOUNDARY SURVEY
SCALE- 1" = 20
D.yo' ,1
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90 d.
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2r ` rfk6.1.-1 e,M r
7
2/• 75 ' -
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LOT 20
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70 .75'
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TOTAL P.03
FEB -15 -1996 15:48
SKETCH OF BOUNDARY SURVEY
SCALE: 1 = 2 '
REVISIONS:
P.03
I zo o
t ` 46
PMTS.
93
NUTTIx
TOTAL P.03
r
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 . .ing during progress of the work.
Owner's Name and Address .
APPLICATION FOR BUILDING PERMIT
orco/`'k
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on
Lot Block
Street and Number where work is to be done.
State work to be done and purpose of buil floors)
New Building Remodeling
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $. Amount of Permit $
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 the 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 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 e of the work such ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on to be perform under this
permit, as are licensed by Miami Shores Village.
Remarks____ (Signed)
STATE OF FLORIDA, I
COUNTY OF DADE. ss.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No ./r Date �' � 4� / Read, Sworn to and Subscribed before me.
Disapproved L _
(Signed) -- ---------- -- L
Da
ur di g Insp r
No.f
�
,19`" j
l
Street
Subdivision V
and for no other purpose.
ddition Repairs No. of Stories
to me well known,
Notary Public, State of Florida
My Commission Expires
NN1NG BOARD DATE
Chairman Member
Member Member
Member ... Member
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 81.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.