372 NE 98 St (10)BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby mode for the approval of the detailed statement or one plans and specifications herewith submitted for the build •
inc 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.
' Date _ M_ _._.__.__ .�. . ,19 .2_
Owner's Name and Address .... 1 ...r C\- .. T..� No.. ..7 Z :...... Street.N 1.
Registered Architect and /or Engineer a — -:r __ _ f• 1 V V(1/,,,,•
Name and address of licensed contractor ii. 1.,.......,-.... r`
Location and legal description of lot to be built on:
Lot Block — �q 2 1 i Subdivision > _
Street and Number where work is to be done 2.e ce}
State work to be done and purpose of building (by floors) -, r "" t
peared
Permit No . Date
Disapproved y............ Date
(Signed)
MIAMI SHORES V I L L A G E
Building Inspector
PLANNING BOARD DATE
Member
Member
Member
Disapproved
or changes to
Chairman
\fcrr,ber
Member ..
Council Approved Date
NOTE: A charge of $1.00 will be made for making corrections
the I'1.,nnir.;; Board.
A re.In.pection fee of $I.00 will be charged
materials and /or workmanship.
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roo f Covering
Estimated Total cost of improvements $ 0 C . J •,„-1 Amount of Permit $..1C
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, P r nxnent Supplement,
and has complied ssith 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 noticcs as arc required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
pcnnit, as are licensed by Miami Shores Village.
Remarks (Signed)..
STATE OF FLORIDA,
COUNTY OF DADE. i ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
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 foregoing application, and that he did sign the same, and that all facts
therein by him stated are true
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
Date
this application niter approval has been obtained Imm
when such re-inspection is made necessary by Improper notice for inspection or faulty
Date 17 Job Address 3 7Z Jd' el
' Tax Folio
Legal Description Historically Designated: Yes / L Ali
Owner/Lessee / Tenant 1 IP•J A fe- I kSoN JvLa A e Master Permit # `7 (0���
CELL_
Owner's Address 372_ ") 6 5d ° ire f ', 7 - Phone 30s - 73;11150 i 30 5 Lox,
Contracting Co. SC Z- 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
lien Al i1 ore H c 'I ,S r_ 4 1-1e,79 Lien M pe' - Z.3 woof) A,t ck, D
WORK DESCRIPTION Pot ,-r rr.J G- o C� K 7c' ! c2 #0-, SE- 7 r // , 1 ; i cit-. r)ow S. ,
TAt, 461° 6 A t- 11 ou c A. d 0U2 / �� ' S'Oz, 4 ; S16 e ?c4 .
Square Ft. Estimated Cost (value) 6 /Qc
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 COMME■CEMENT.)
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. F ermore, I authorize the above -named contractor to do the work stated.
Signature of owner and/ Condo President
Notary as to Owner and/or Condo President
My Commission Expires:
FEES: PERMIT
APPROVED:
Zoning
Mechanical
PERMIT APPLICATION FOR MIAMI SHORES
RADON C.C.F.
tor or
6i or or viLI�,R
fires: GLADYS
NO'T'ARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC71410.1
MY COMMISSION EXP. MAR. 1,2002
Signature of Contr
Notary a o Contra
My Commission E
NOTARY
7-1-74t714.0 Pe-ee
1 32 0/
er- Builder
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BOND
TOTAL DUE
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