816 NE 99 St (5)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 9 9 if Job Address 8 ! � p /J q' Si. Tax Folio
Legal Description Historically Designated: Yes No x
O w n e r / L e s s e e / Tenant ay & Y l fi F f KV44 M (G N EL 2fTE4V L- Master Pen nit # 3 gad- T
Square Ft. Estimated Cost (value) 121000,
Signature of owner and/or Condo President Date
APPROVED:
Zoning Building AA 1
Mechanical Plumbing
Signs a of Contractor or Owner- Builder
Electrical
Owner's Address Phone '7S -61 D k
� 1 t �
Contracting Co. 1L �W � /2 11 Address
Qualifier SS#
State # Municipal # Corr
Architect/Engineer Ad ial-- .
Bonding Company Addre
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 5 x . �-t o 1, - pm KYri) &- , Poo F Qik) � IV h-
IA A 1, D 1\. \T
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.
Date
r
Notary as to Owner and/or Condo President Date N,6tary as to Contractor or Owner- Builder Date
My Commission Expires: Il4y Cer missi _ �� v SEAL
P (2Y P(� OI�
er SANDRA C1 F1lOo��lE!.
` _ ( COVI ISSIOFI NUVEEl�„
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M_ COUVIISSION .E:1P. 1
FEES: PERMIT ( RADON C.C.F. ,Sd NOTARY (�- TOTAL DUE CV s"
Engineering
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 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 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
Registered Architect and/or Engineer
Name and address of licensed contractor 4 Wd
New Building Remodeling
73
IrY�e�t�
Location and legal description of lot to be built on: Q �J
Lot /e 4 Ey // Block 7 A 7/1 Suubdivision _ 21e.. 5 c " 3 1/ �' "
Street and Number where work is to be done 7j(p / / 0 79 v '
State work to be done and purpose of building (by floors), state exterior colors (submit samples)
Date
Addition
To be constructed of Kind of foundation Roof Covering
,
Estimated 'Ibtal cost of improvements S E �S // � � Amount of Permit S 31 6-t
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 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 obligatons 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 (Signed)
and who. being by me first duly sworn. upon oath deposes and says that he is the
// °z f /s7
Permit No.
Disapproved \ \-- Date
(Signed)
Building Inspector
Repairs No. of Stories
mnt,
Date r: 19
No Street 7) 9'y 51
/L/ a4C5 2 J
STATE OF FLORIDA
COUNTY OF DADE. } ss.
Before me. the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments. personally appeared
Made I on I'(, C o*
Read, Sworn to and Subscribed before me.
PLANNING BOARD DATE
7s_0 y-
-
and for no other purpose.
to me well known.
nw ner
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.
7
Notary blic. State of Florida
MTV PUN C - STATE O LORSOA
My Commission Expires ItY CO1-1:1TEST011 E.XL_O7C 11,1flfl9
CONED THRU GE OM:' iff$: Wigs,
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of $25.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.