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PAINT HOUSEPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 3/2. /f Job Address t t. o / A/4 / 42/ 57 Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant /►M ,4 L col. a F/` Master Permit # t/ a$ 6 Owner's Address ) 2 o 1 /V 1 d / 5 7 Phone Contracting Co. &d3 S <C_ 2 / Al .41 �_v1/� /.t1 Address g /LIE 9 P57 Qualifier Phone 23 �t3'L State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELEC TRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN ' G ?ReSs te- i-_ iL. - W A-'LL -s � ,�t• 14t. �, ;� r r k '.. TTY � ;, Square Ft. Estimated Cost (value) 0 2 ! GJ WORK DESCRIPTION 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 d• the ork stat 1 4 . it Jai or bons as to Owner My Commiss Expire : ANNE WALSH WRIGHT MY COMMISSION # CC 386514 EXPIRES: June 23, 1998 Bonded Thru Notary Pubkc Undxwrtt is FEES: PERMIT 4' 7 ' APPROVED: Zoning Mechanical Building Date 3 -1 / -pg - Notary as to Contractor or Owner - Builder My C.C.F. 1, g Si a ature of Contractor or o wner- Builder 12 O�PY P(4 OFFICIAL NOTARY SEAL SANDRA BI MONTIEL * COMMISSION NUMBER y f Ar a CC401261 OF f` �4. MY COMMISSION EXP. AUG, 17 1998 NOTARY Electrical Date Date 3 -� c.) — ?er 7 BOND TOTAL DUE qL AS Plumbing Engineering Owner's Name and Address Disapproved ) Date (Signed) 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 build • ine 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. �� �cr�.........._ _ No.(. �...__..... Street.i C 1d....i Registered Architect and /or Engineer Name and address of licensed contractor..� L . 1 ._. n..t._ 2& 4 �..,r. Location an legal description of lot to be t Lot 7 Block Subdivision.a g .mac _. /1_. 17 6, -S oek J • Number where work is to done../' l _.... C � ��5_.._ <! S Street and . trmbe be �� �:��i� �. _. State to be done and purpose of building (by floors) _ l.zK �.1..4...C(e . ` _37 iktcdaraP474 W-76 f7 and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind / of foundation n Roof Covering !� Estimated Total cost of improvements $ 4° 4. Amount of Permit $.. 1 [.t 0 0 Zone cubage required Plan Cubage Distance .to next nearest building Size of Building Lot Maxirnum 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 ‘‘'orkincn's Compensation Act, being Section 5966. Compiled General Laws of Florida, Pertn:tnt•nt 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 subcontr ors, to be performed y der this perrnit, as are licensed by Miami Shores Village. `! Remarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. J ss. Before 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 sta a true. Permit No..__ C ? Date ( 4 t ......._.._._ Read, Sworn to and Subscribed before me. Notary Public, State of Florida Building Inspector My Commission Expires /6 to me well known, PLANNING BOARD DATE Chairman Member M1crr.ber Member Member .. .. _ .....__..._._..._.r...._....... 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 Plannir.g Board. A re fce of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials anti /or workmanship. STATE OF FLORIDA, COUNTY OF DADE. ss. Permit No Disapproved ( Signed Chairman Member Member 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 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 he in 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 e (— / No. J greet Registered Architect and /or Engineer e C' � Name and address of licensed contractor Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done State work to . e do and. pu 'Lbuilding (by floors) ___ ' d for no other purpose. New Building Remodeling Addition Repairs o. of Stories To be constructed of Kind of fo Estimated Total cost of improvements $ OA. �_ r-� -_ Amount of Permit $ 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 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 subcon)ractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed !�� _ p __. � L_tF U Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared and who, being by me f rst duly sw n, upon ath deposes and says that he is the of the above described • struction, neat he h s carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated . true. Read, Sworn to and Subscribed before ine. Notary Public, State of Florida Buil. ing Inspector My Commission Expires PLANNING BOARD 1 DATE Roof Covering to me well known, 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.