70 NE 99 St (11)Date
Legal Description
Owner/Lessee / Tenan
Owner's Address
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Addres T O N L ! 9( Tax Folio
Historically Designated: Yes No
Master Permit # 9 S5 g 9
6v p
70 Nz c7
Contracting Co 1 Cc tad! + 1 ilu
Qualifier S et V \
State #
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one):
BUILDING ELECTRICAL PLUMBING (MECHANICAL) ROOFING PAVING FENCE SIGN
WORK DESCRIPTIONS \P- (1)\A C tc C / u 01' (A H V klagai Z VZ
Square Ft. Estimated Cost (value) )(
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.
c
Notary as to
My Commission
APPROVED:
Zoning
Mechanical
?S‘nature of o • er and/or Condo President
f Fl • N OTARY S
tif LADYS J VILLAR
' .., CSTATEOFFLORIDA
.p, �eownit
• OMM •' • R.
Municipal #
to
-.20/
t
Competency #
Address
Address
/ Oc 14 1( 52- 01-O ti---S7 -S7 —
FEES: PERMIT RADON C.C.F. / NOTARY
Building Electrical
Phonl 3d5! 7 7 /2I/
Address! / 12b 8Q ST 1/4 330')
ss# phony 305"
o S —7S 9 1
Ins. Co.
�6 8'S. co
k X t 27
ture C • ntractor Owner - Builder /.
Notary : -: to Contractor or Owner- Builder -
My Commission Expires:
OFFI
GIADYSJ VILLAR
MARY PUB= STATE OF FLORIDA
COMMISSION NO. CC714103
Or MISSION EXP. MAIL
ens
BOND
TOTAL DUE 7 0 - °LC)
Plumbing Structural Engineer
ITE
BATH TIB
B IDET
8 I SIASrER
014011
IXRINKING FOUNTAIN
FLOCK CRAIN
GRE.LSE TRAP
INTERCO
LAVATORY
L UIN Y TRAY
CLODS WASS
S1 -IO111E
SINK. POT/3 MP.
SINK, RESIDENC
SINK, SLIP
T EWt1iARY EATER am-;
URINAL
RATER CLOSET
IFOIRECT WASTES
IYATER SLPPLY TD:
A/C UNIT
F IRE SPRINKLER
' 1HEA E A 1161 .
HEA E
LAWN S?R 1WQ=3 -TEL
SUING POOL
WATER SERV I4
SEAS CONNECT III6
UT IL TTY- SETTER
UTILITY -MATER
SEPTIC TANK
RELAY
CRAWLED, 4- TILEIRES.
PtD1P & MAIM TIC • TANK
SOAKAGE PIT CU. FT.
CATCi BASIN
OISCIARC' WELL
OtSTIC AEL
AREA CRAIN
ROOF INLET
SOUR RATER HEATER
FIRE STAIOPIPE
POOL PIP
LAWN R I KKLER SYSTEM
GAS R Z
WAR _ T (US)
GAS P IP UG
.=.o ENUUM T O ! PERMIT I APPLICATION
=U � � I`(c.: rtr ►,� {" i
(AN A2JLTC. ___Y FOR 3UI_LDING P_RNZT MUST .000MP NT THIS ADDENDUM. _T: A =ASTER PERMIT
03 = NzD , — HZ Ceti=? ' S NOT RZZID S : GNATC =.: NOD ;ACT BE ?RESENT ON SU3Sr4U_YI' APPLICAT IGNE . j
PLUM5ING
ELECTRICAL
MECHANICAL
UNIT
RETACLES
I
0vEN
FE
SWITCH CUTLETS
1
LIGff CUTLETS
say la TUMMY
RY
Sava SIZE IN ALPS
SERVICE REPAIRAETS. Ca
APPLIA•C: OUTLETS
RAIGZ TCP
RATER HEATER
O(ITCRS 0- 1 FP
10TCRS OVER 1- 3 If
1ITCRS OVER 3- 5 IP
CTCRS OVER 5. 8 If
1ITCRS OVER 8- 10 IP
1OTCRS OVER 10- 25 FP
1DTCRS OVER 25-100 FP
1OTCRS OVER 100 FP
A/C A DN !
TELEVISION OUTLETS
AIR COFOITIONERS
STRIP HEATER
GEKRATCRS MAMMAS
GENERATDRS TRA16rtkRS
EENSATCRS TRANSrCR1ERS
SPECIAL PURPOSE
' I CUTLETS CCIAL
• SIG( TLBES
SIGN
SIGN TIME CLOCK
F IXTLRES
REIMPECTION
UNIT
r c.
VIOLATION
REINSPECTION
1 1
1 1 1
1
rT�I
SPAC FF_ATERS
OENTRAL HEATING
A/C (WINO)
A/C (MORAL)
CLOT Il�Rlt
IRR!EiRAT ION
MESS AND PRESS PIPING 1
11 01354220 MKS
ABOVE GiC o TANKS
(
U .F. PRES LRE VESSELS
1 1
STM BOILERS
FIT RATER BOILERS
1
IMANICAL VENTILATION 1 1
TRAIIS?ORT116 ASSB6UES 1 I
Er.EEYATTRS/EC.a.4.ATCRS
FIRE SPRIIBQ.f SYS1BSS
1
LING TOI8S
1
(
1
1 )
AMNIA
VIOLATION
1
L
1
1
1
1
Application is hereby wade 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 pregress of the work.
�. Date..._..._... _.......� ��.__ _ 7=
Owner's Name and Address R S A - A 9 L V/. /C ' Q M ? M ? ._ No. ..7 . Street.. . .-
Re Architect and /or Engineer
Name and address of licensed contractor Gem To dZ Y A C Oii/ l>. 616 Seci 4
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done 70 L-'E 99 Sr
State work to be done and purpose of building (by floors) _ _ ...
P &'iU7' (hi LT s r_ _ l 77, v5 _, A-CH . _fJ J 7 ) t7W e W'WJ 5•TTe/ /fE p-TE2 &c/-
/ and for no other purpose.
New Building Remodeling f/ Addition \ epaira No. of Stories /
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ 2 ,e 6O0 °g. 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 h ' site of the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only suc sti15 on actors, oh twork to be perform d under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Disapproved
(Signed)
APPLICATION FOR BUILDING PERMIT
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 rea• . - oregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No.._ ( 5 " Date T`� Read, Sworn to and Subscribed before me.
Date.
Building Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT.
0/1:101/ . re-7t & ..0e 1
Notary Public, State of Florida
My -. • , mission Expires
f 72 4/9
r
2 6/7..5.9 - 7 /.
to me well known,
P ANNINC BOARD _.._.... ..DATE
Chairman / Member
Mfcrnbcr 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 fce of 31.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.