801 NE 98 StMy Commission Expires:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address y Y V/ / V C q g (7 / Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant y �11m T / r Master Permit # 1$ 1 /3 2.
Owner's Address gai ti, ,%, Si- Phone 1. 0,34
Contracting Co. 0 VA. it i. N E-. Address
Qualifier SS# Phone i -kr>
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): ' !AIDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION X
Square Ft. Estimated Cost (value) x _ 0
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.
OWNERS 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.
)4r Z 2
Signature of owner and/or Condo President Date 'Signatur• . Contractor or Orr- BLU }'1 r to
f 1C�bri` egritC,G'
Notary as to Owner and/or Condo President Date N as to ontracto n or er - : s �y �T. ': Da
My Commission Expires: ) ;t rfl�; Y1' J`'!�C4'1A'r:i
" I -15 )i iN t`C./14ity
FEES: PERMIT I R ; RADON C.C.Fr) NOTARYS BOND /)
APPROVED: TOTAL DUE 6C
�I
Zoning Building (✓ ` 4 1 Electrical
Mechanical Plumbing Structural Engineer
• MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE: , ` - 27—
OWNER'S NAME: n . i PHONE: 301 7J74 J
ADDRESS: , 11 `r I LLf
********************************** * * * * * * * * ** * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE:
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
All Elements on the site must be listed and indicate the color to be painted.
Walls
0
Fascia
Soffit 0-//71
Roof
Flower Bins
Shutters
Awnings
Chimney
Doors and door jams
Garage Doors
Railings
Fences
Decorative Metal
All brick (simulated or regular)
Stucco Banding
Any other stucco features
Accessory Buildings
Other
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. I authorize the above -named contractor, if applicable, to
do the work stated. Furthermore , the paint colors will be as per the attached
sam .. ee-7
Signature of Owner Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED:
Building Official
114
Date
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and leg description of lot to be built on:
Lot 84 4 9.. 4 9.. /7 Block 7 0 ?
Street and Number where work is to be done
New Building Remodeling
Council Approved
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.
Date 144 (:/
` �� 19 1's
O Y / 'T V No e) / Street 1U • C �'�!
o
State work to be done and purpose of building (by floors), state exterior colors (submit samples)
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements S J (NJ Amount of Permit 7;5-27
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
Subdivision
Addition
The undersigned applicant for this beikkigg 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
' Miami Villa
un d
under this permit, as are licensed b y M ramr Shores
•e.
Remarks _* bn i �,. A G (Signed) /®.3 XV�_
a v
PJ fit e� ° =
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
and for no other purpose.
Repairs No. of Stories
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. / / 3 Date Read, Sworn to and Subscribed before me.
Disapproved , Date
(Signed)
Building Inspector My Commission Expires
Notary Public, State of Florida
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
ate Disapproved Date
NOTE: A charge of 525.00 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 525.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and,or workmanship.