73 NE 99 St (3)Date ii/,c /4,,c- Job Address 7.1R /)4:99t Tax Folio
Legal Description •
/ Lessee / Tenant
Owner's Address
Contracting Co. 4vti.e / ./ - ' 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 SIGN
WORK DESCRIPTIOr( ge — che b()k Fci?e— & .5( i)/Y Pl. Ro9f g / eC
&-de. yew-
�//�
Square Ft. Estimated Cost(value) 4 o
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.
S
Signature of owner and /or Condo President gnat Contract dr�or Owner- Builder
Date: Date:/
Notary as to Owner and /or Condo President Notary a - CimArac tartAfIF
My Commission Expires:
** *
FEES: PERMIT 3 (2.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
avq rj 6 t
9.? 114=. q1 r�r � lA - eori chele- Pi
Master Permit #
Phone 000 e- 4
My Comb• , • • p(1prWres :M MONTIEL
t� i * COMMISSION NUMBER
CC401261
,�. � � MY COMMISSION .EXP.
RADON C.C.F.
APPROVED: Fire
Zoning Buildin
Mechanical
* AUG 7
o
NOTARY-_ d
S.
Plumbing
-Builder
* * *
TOTAL DUE >_)
Other
Electrical
Engineering
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 progress of the work.
Owner's Name and Address 6Thdie a
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on: /
Lot Block I S division_
oors )A_ '
and .r no oth:` purpose.
Street and Number where work is to be done
St e ork to be d e ,dd4jurpose of building (by
STATE OF FLORIDA,
COUNTY OF DADE. Ss.
Disapproved Date
(Signed) ..
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date
/7
No Street ______________ L__
'0 ' amte.nded
Wt. .gr
New Building Remodeling Addition
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ '4 9 Amount of Permit $
Zone cubage required _Plan Cubage
Size of Building Lot
Repairs No. of Stories
/03 rx 1/5
Distance to next nearest building
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 the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such bcpn tcjs work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks 1 (Signed)
Notary Public, State of Florida
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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.
Permit No Date Read, Sworn to and Subscribed before me.
Building Inspector My Commission Expires
PLANNING 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.
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