PAINTPERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY) �
Job Address //,6 ��� Tax Folio /1 1a ,9J / /9 0/ -
Legal Description `1
Ow er Lessee / Tenant g�� 4I 4' w�
n
Owner's Address phone
Contracting Co. G
Qualifier
State# Competency #
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION ,/..du"2Z/ /9 i
D
Square Ft. Estimated Cost //
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. 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 al applicable laws regulating construction and zoning.
rthermore, I at1thorize ' bhe )bove -n eed contractor to do the work stated.
YY /v■
Signature. of,Owner\an /or Condo President
Date:
No ry a to Owner and /or Con o President Notary as to Contractor or Owner - Builder
My Commission Expires: /.///0 My Commission Expires:
* * * * * * * * * * * * * *
PERMIT FEE: APPROVED: Fire Other
[ Zoning Building ` ) )° Electrical
S.o 7/d r
i G Mechanical Plumbing Engineering
/2 f S' „, r
Address
SS# - - phone
Master Permit #
Ins. Co.
Signature of Contractor or Owner - Builder
Date:
Owner's Name and Address i�C 1G Clv�t 1 +0n
Location and legal description of lot to be built on:
Lot
Street and Number where work is to hp done
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.
Registered Architect and/or Engineer h e
n 0 t
Name and address of licensed contractor
Block Subdivision
115 >v / St-
Su ing (by floors), state exterior colors (submit samples)
_ and for no other purpose.
Ne Beige Tint _ _ _ _ BM-80725_ [ing Addition Repairs ✓ No of Stories /
To be constructed of / Kind of foundation of Covering "—�
Estimated Total cost of improvements S $ 200 6� Amount of Permit S .5
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 subcontractors 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 undersign agrees to employ only Bch su contractors. •n work to be performed
under this permit, as are licensed by Miami Shores Village.
Remarks (Signed)
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
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 foregoin• application. and that he did sign the same. and that all facts therein by him stated are true.
Permit No. zi I v , ( Date '' Read, Sworn to and Subscribed before me.
Disapproved Date
(Signed)
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of S25.00 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.
Date 3 1 L�
No. 11 6.( Street
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Notary Public. State of Florida
19 S
/01 SA-