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DRIVEWAYPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date ( 5 9 Job Address 1) S co N .E / v I g-/ • Tax Folio Legal Description / ° Historically Designated: Yes No Owner/Lessee / Tenant C b inn Q �> Pc(1 • C 1-It t en) Ffd r\l Master Permit # *-53, Owner's Address ` Phone 7 S 8 ? f 2 Z Contracting Co. ( G w ( Le.-►'L) 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 FENCE SIGN WORK DESCRIPTION 2rn a /Nei rz_ Cunc_l'Z-e Square Ft. A p2 300 z Estimated Cost (value) T i SO -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. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable la . egulating construction and zoning. Furthermore, I authorize the above -tined contractor to do the wprk stated. FEES: PERMIT RADON Notary as to Owner and/or Condo President Date My Commission Expires: Signature of owner and/or Condo President Date Signature of Contractor 4i Owner - Builder I t Date �v o ,./..9- - /51, Notary as to Contractor__or Owner - Builder=' Date My Conunission{,Exliite§ AAL G\;c ?ARV MGAB. oAi�:�2A Ca L c i"i .L {`i x!' 11 ©01'.3:15(3:0N ClUND p u�, Ca 2 1 Q ZI Cr j1 0 : n `.191^ =� C.C.F. A. NOTARY 6 BOND b TOTAL DUE APPROVED: Zoning Building � 1) 1 C ) Electrical Mechanical Plumbing Engineering Owner's Name and Address STATE OF FLORIDA, COUNTY OF DADE. ss. (Signed) MIAMI SHORES VILLAGE s i 4 65' BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement or toe plans and specifications herewith submitted for the build • inc or other structure herein described. This application Is made in compliance and conformity with the Building Ordinance of Miami shores village, ge, Florida. and all provisions of thc. 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 _ MI. •_•• 1 T * ri: • :: »••:•• _: Namc and address of licensed contactor - . ..s5 c " Z 43 ' '$ — .J -PIe°1 Location and legal description of lot to be built on: Lot Block Subdivision ._.. __.. 6 Street and Number where work is to be done //t,.5 -Cr -'2 State work to be done and purpose of building (by floo _ _._. 7 ' and for no other purpose. New Bui!ding Remodeling Addition Repairs No. of Stories • _ To be constructed of Kind off foundat_lofs Lod Cpvering Estimate Total cost of improvements $ 70 ' �JJ'r�— Amount of Permit 3... v ' D // )) 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 hercby 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 inspects on t ite of the work such public notice or notices as arc required by the Act. The undersigned agrees to employ only such subcon II •r to be pe•rmed under this pcnnit, as are licensed by Miami Shores Village. i �/� Rem:uks (Signed) e1 , i Bcfore 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 read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true.. y' Permit No.._. 4 ^ Date 1 I k Disapproved to Building Inspector ( No.. /...1. Street. / 01 ,Sr Date... Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires _....._....._ to me well known, PLANNING BOARD DATE Chairman Member \fcrnbcr 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 Ow 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 anti /or workmanship.