165 NE 98 St (11)PERMIT APPLICCATIOON FOR MIAMI SHORES VILLAGE
Date b l Job Address lc,rkL ?2-
r-" r Tax Folio
Legal Description Historically Designated: Yes No (`
Owner/Lessee / Tenant I O r-S ' \ k C- C (,)A
Master Permit # .9s7 #
Owner's Address l ii c q a L C Phone _s z , ...s 7.5-1 0 ( l
Contracting Co. ; l- n/VC -- Address 3 05 '" qS L t ^ t s q I ( \n/
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company
Mortgagor Address
Square Ft.
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVIN
i 6
WORK DESCRIPTION f% t 'j c. cc: 3 Q '-( lY
,r,t.A_A,jk fi Al... A.z_k_ )/f ' Pi/ lffi te
Estimated Cost (value) J G "` `
OV3
e of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT RADON ,,' C C
APPROVED: dOlh /' 5 Alifidd
Zoning /
Address
e of Contractor or
Electrical
er- Builder
S 1
My Commission Expires P . ANGELA to i gfi yEf
; -' a ce7a60<:7
AY COMMMtSSJON
1;s �OF F .° NOV. )::;,?/.
NOTARY D 6 BOND
TOTAL DUE
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
co truction and zoning. Furthermore, I authorize the above -n contractor to do\the work stated
°� ����✓ /6
00 -0
tary Contracto er- Builder Datel
Mechanical Plumbing Structural Engineer
STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affiant,
attached survey, performed by
Further, Affiant sayeth naught.
M iami SIlorQ�
(L),vz , does hereby attest that the
(property owner)
1 —G■Aexel #. (TALC ( A
AFFIDAVIT
(name of surveyor's company)
performed on LlM rl , is an accurate representation of the existing conditions and
(date of survey)
locations of all structures on the property as of this date.
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..
/ c
t/Property owner
Witness(sign and print) Witness(sign and print)
SWORN TO AND SUBSCRIBED before me thi day ,�� :_ J
1
. 2_ 0
Affiant is personally known to me, produced .L as identification.
R y p OF CIAL WO. ARV SEAL
eG ANGELA M ' CKER
2 'ck(f3 n coesrissm s 3E
N, III' -S a CC766697
"F,
�• env COmmis.:ON E P RFS
OFF\C ,2oO
STATE OF FLORIDA )
) SS.
COUNTY OF MIAMI DADE )
STATE OF FLORIDA )
) SS.
COUNTY OF MIAMI DADE )
(ACKN O WLED GEMENT- INDIVIDUAL)
The foregoing instrument was acknowledged before .me .o
Signature of Acknowledg
(ACKNOWLEDGEMENT - CORPORATION)
�✓��fi VI ON by
, who is personally known to me or who has produced
as ident 'on and wh• did (dicLnot) take an oath.
Name of Acknowledger:
(Typed, Printed, or Stamped)
Title or Rank:
Serial No.(if any):
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):
This property described as:
Lot 23 and the Fast } of Lot 22 ,
.Mock 17,
AN AMENDED PLAT OF MIAMI SHORED
according to the Plat
thereof, as recordad in
Plat Book 10, Page 70�
of the Public Rcc - - de of
Dade County, F- .rida.
1
0.5o'
05o
Lc,
f�3
S'
N
eti
o
A0-04
•95
'SR
0
i5:0LC l2 , 45p,4d i ,L)
/5.4o'
/Zoo v,
1,
4,111 1 A1111 %%111111111 4 R 1.II:MA'111ME
AAp 1111 11NI/.IA.1,1. *AI%1 h 1.1;41. 11a'
11.41[.14,41111.M.► 11 M1/ IIlM
wee 7'S.Ov P
, wire
A ROUNnA1IY SutvtY
t hetph1 tautly that the stover taw*.
SECTION NO. 1,
6
4
We
op
0\
°,°
/0,
.. /.4
2
6 .5 . 2A
, .P61 1
Por-Zalv co
GO ' 7,s/o £/( ' 7 /
vltC)DfRTY Uf M cClune, Donald L. and Debra J. lb
4.fi�;
ci .
375
\II
W
V oa
e ° L
1\ z1,,,,__)
co ,
` p ‘''. 0 " 0
pl
111
1 Y/ Y "I 1111V
Florida.
LANNES AND GARCLA, INC.