PAINTApplication 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 regula-
tions 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
Distance to next nearest building
Permit
Disapprove
(Signed)
MIAMI SHORES VILLAGE
APPLICATION FOR BUILDING PERMIT
BUILDING INSPECTION DEPARTMENT
p R Date_ 19
No .-- - -
Registered Architect and /or Engineer
Name and address of licensed contractor G Q / R ��. �� • &.
Location and legal description of lot to be built on: ?A C a I cJ L. l g fL et ®f,
Lot___.__ —__— Block___._ Subdivision
Street and Number where work is to be done
State work to be done and purpose of buildin(by floors
New 13ui ]ding ________ ______________________ Remodeling Addition
Estimated Total cost of improvements S.._ _:1_ L7 Amount of Permit $
To be constructed of__– __________________ Kind foundation R,ofering
Zone cubage required________ Plan Cubage
Maximum live load to be borne by each floor
1 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 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
Chairman
Member
Member
Council Approved___
$1.00 will be made for
Date
Size of Building Lot
tgne )
My Commission Expires__
Member
Member -
Member
Disapproved
DATE
Repairs ''
n to and Subscribed before me.
Notary Public, State of Florida
__and for no other purpose.
No. of Stories..
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths nd take acknowledgments, personally
appeared
to me well known,
and w o, be' s : by me first - « y sworn, upon o th deposes and says that he is the________
of the above : scribed co ion, that hp has' carefully read tl foregoing ap ; tca�io and that he did sign the same, and that all facts
thereic by him - ted a
Date
NOTE: A charge of
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
making corrections or changes to this application after approval has been obtained from
Date 4 d Job Address-P 3 /V ve 5/-Tax Folio
Legal Description Historically Designated: Yes >/ No
Owner/Lessee / Tenant f 0 u)/7 e r2i,,, &,3 ` 6 Master Permit # q Lid_ 7�
Owner's Address 7.-3 /l/ G 9 b /6 -ST . Phone 26.5 J - ef 7--//3/
Contracting Co.A 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
a / /-) eid6,6 o Aoces A/ B41 /
i,P._r
WORK DESCRIPTION
Square Ft. Estimated Cost (value) .30
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 perfonned 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.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
- oh ...' .. Signature of y �r er and/or Condo President Da ignature of Contractor or Owner - Builder Date
EZ36 - / /0- ily- ‘3/ -O ac
Z -22- -7 y
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner- Builder Date
My Commission Expires
OFFICIAL NOTARY SEAL
GflADYSI VILIAR
1 'Al2Y PUBLIC STATE OF FLORIDA
COMMISSION NO. CC714103
,.MY COMM sION EXP. MIL 1,2002
FEES: PERMIT V RADON
My Commission Expires:
C.C.F. 2,V0 NOTARY S� BOND
APPROVED: , / I/
TOTAL DUE `7
11
Zoning Building� Electrical
ical Plumbing Structural Engineer
4/E At
DESCRIPTION OF THE PROPOSED PROJECT (Explain what changes will be made
and how they will be accomplished - use continuation sheet if necessary - all applications
shall be accompanied by at least one 3" x 5" photograph of the property):
p ai�ninG e—Xte- i OF- )-se
8e nin Moog e 1 g/ - W a /S
tiuk ih imndowspooRs
Oen fAmin i° )oo e 605 ._ Wood / Irfl -
coxes WJ4 ?eA) Boot
TIFY TO THE BEST OF MY (OUR) KNOWLEDGE AND BELIEF THAT ALL INFORMATION IN
CATION AND ITS ATTACHMENTS IS TRUE AND CORRECT:
SIGNATURE OF APPLICANT(S):
SIGNATURE OF OWNER(S):
FOR BOARD USE ONLY
APPLICATION DATE (date application received by Secretary of the Board):
DECISION OF THE BOARD (circle the appropriate number):
PROVED
2. APPROVED WITH CONDITIONS (set forth conditions below):
3. DENIED
SIGNATURE OF CHAIRMAN:
CERTIFICATION
DATE:
DATE:
DATE:
DATE: 2I144”