343 NE 99 St (7)Qualifier
State #
Architect/Engineer
Company
Type(circle one
WORK DESCRIPTION
Square Ft.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 3 3 Address / L , U 7 �S- Tax Folio /� 3.2� ,1 53 '
Legal Description �T Af & 4A:/ 'e i�% - ' �� /AV.
Owner / Lessee / Tenant j l) / C /Y //'/� Master Permit # -Il°`4
Owner's Address 3 7? /(/ .. ,9,5f5:/ Phone ���
Contracting Co. /6 e�'Or, Tlil e ,i�! /l��S'c7�C/�1c4' 570 "5! //C.?
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/,.//4/ ( / SS4t '
Municipal #05.S 4� /c,SS Ins.Co. �a�Lt - .
r Address
y Address
Mortgagor
1� �4�� �/ 7 5 �1/ Y1�/ �i"ld�'�� di/2
Estimated Cost(value) ` 9rd
: BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFIN$ PAVING FENCE SIGN
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 constr and zo g " rthermore, I
authorize the above -named contractor to do the work stated
Signature of owner and /or Condo President ignatur, o Contractor or Owner- Builder
Date: Date: /P// 9
Notary as to Owner and /or Condo President ar as to l " ^;.1, :c.:;545 � x My Commission Expires: y Commission
•
APPROVED: Fire
Zoning Buildin
Address
�/
FEES: PERMIT A 77 ( RADON C.C.F. '! b NOTARY 15 TOTAL DUE t r
Other
Mechanical Plumbing Engineering
**
Electrical
ii
1b2
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
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 at building during ptqgress of the work.
Owner Name and Address ��...,I!il L.(;G,, t tom.,. ...A.--
Registered Architect and /or Engineer
Name and address of licensed contrjkctor......Zt
Location and legal description of lot to be built on:
Lot Block Subdivision
•
Street and Number where work is to be done 3 ' 3 2G,C..
State work to be done and purpose of building ( floors)
New Building Remodeling Addition..
Amount of Permit $..
..Plan Cubage
Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building.
Remarks.---- .....__._..__ - - ---_ ._.. _._. —..__ (Signed)
STATE OF FLORIDA,
COUNTY OF DADE.
Permit No.
j ss
Disapproved
(Signed) ...
Date
■
Date... /..' ..._..»..._........»�....._.... _........ 19 ? ..-
.... No: .......... Street_..l.Z'/ .. /
.1.. 5...1
t .�... • ............
2 74.;
� t l r a:. Repairs
--• -- and for no other purpose.
No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ 'DD
Zone cubage required
Distance to next nearest building -
1-...s . .0_ . ..
All notices with reference to the building and its construction may
be sent to
The undersigned applicant for this building pennit 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, Pennanent 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 w- uch ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such su rspa, . rfbny under this
permit, as are licensed by Miami Shores Village. , _L � - PI
'r -- te •/
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.
T — (f- Read, Sworn to and Subscribed before me.
1.. Date. _... -
Building Inspector
PLAN ' ING 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 $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
Notary Public, State of Florida
My Commission Expires
to me well known,
,
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